Felicia Ornelas
Torrance,CA
Summary
Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty. Resourceful Customer Service Representative known for high productivity and efficient task completion. Specialized in communication, problem-solving, and time management skills, ensuring smooth operations in customer service environments. Excel in listening, empathy, and patience, which are crucial for addressing customer needs effectively and building positive relationships.
Overview
6
6
years of professional experience
Work History
Customer Service Representative
Magellan Health
05.2023 - 05.2024
- Responsibilities include answering incoming calls related to eligibility, benefits, claims, and authorization of services from members or providers
- Actively listens and probes callers in professional and timely manner to determine purpose of calls
- Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality
- Resolves customer administrative concerns as first line of contact - this may include claim resolutions and other expressions of dissatisfaction
- Demonstrates flexibility in areas such as job duties and schedule in order to aid in better-serving members and help Magellan achieve its business and operational goals
- Educates providers on how to submit claims and when/where to submit treatment plan
- Identifies and responds to Crisis calls and continues assistance with Clinician until call has been resolved
- Responsible for meeting call handling requirements and daily telephone standards as set forth by management
- Answering over 30 calls per day.
- Answer incoming calls , probe to identify callers concerns and communication information related to eligibility , pharmacy , pharmacy claims, and authorization inquires from member and providers
- Quickly identify and resolve simple to complex concerns in timely manner to support one call resolution.
- Assist escalation calls , Crisis calls and file complaints on behalf of member in communication to California Department of Health Care Services.
- Continuously demonstrates adaptability , resilience, and passion for serving callers and meeting business requirements.
Escalation Team/ Call Representative
See's Candies Inc
08.2022 - 04.2023
- Handle all internal and external customer service calls, including order entry, processing adjustments, literature requests, tracking orders, creating new accounts, and completing required paperwork.
- Provide effective and timely resolution for all phone order and email-related issues. Record customer compliments and complaints, including processing adjustments for customer complaints. Build and maintain solid customer relationships by providing excellent customer service to all inquiries and customer contacts via phone and/or email, with a focus on See's Core Principles.
- Managing projects in timely manner provided by manager. Supporting New hire training. Explaining the core values of the company, showing examples of how our current system works. Answering any questions new hires may have. On floor nesting supervisor , assisting set up new computer.
- Supporting new hire's navigate as they take their first call. Escalation team member, helping call representatives navigate the website, guiding them to their resources. Answering questions they may be uncertain about.
- Maintained up-to-date knowledge of products, services, and policies to provide accurate information to customers during calls.
Cashier
Jons Fresh Marketplace
01.2020 - 06.2020
- Greeted customers entering store and responded promptly to customer needs.
- Interacted with up to 40 people per hour.
- Built relationships with customers to encourage repeat business.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Worked flexible schedule and extra shifts to meet business needs.
- Helped customers complete purchases, locate items, and join reward programs.
- Restocked and organized merchandise in front lanes.
- Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
- Stocked, tagged and displayed merchandise as required.
- Assisted customers with returns, refunds and resolving transaction issues.
- Handled cash with high accuracy and took care to check bills for fraud.
- Used POS system to enter orders, process payments and issue receipts.
Authorization Specialist
Express Imaging Services
02.2018 - 11.2018
- Processed and certified documents for accuracy and compliance with government regulations.
- Looking at over 50 documents per hour.
- Communicated with people from various cultures and backgrounds on application process.
- Assisted clients with accurate eligibility form, application and document completion.
- Resolved discrepancies with client applications to verify eligibility.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
- Verified application and account details to accurately asses credit and financial risks of potential clients.
- Collaborated with healthcare providers to obtain necessary documentation for prior authorization requests.
- Contributed to team goals by consistently meeting or exceeding individual productivity targets for processing authorization requests.
Education
Associate Degree - Medical Field
American Career College
Long Beach, CA2014
Skills
- Customer Service Skills
- Critical Thinking
- Computer Skills
- Data Entry
- Sales Force
- Time Management
- Problem Solving Skills
- People Skills
- Empathy
- Typing Proficiency
- Reading Comprehension
- Staff Training
Skills
Timeline
Customer Service Representative
Magellan Health
05.2023 - 05.2024
Escalation Team/ Call Representative
See's Candies Inc
08.2022 - 04.2023
Cashier
Jons Fresh Marketplace
01.2020 - 06.2020
Authorization Specialist
Express Imaging Services
02.2018 - 11.2018
Associate Degree - Medical Field
American Career College
Similar Profiles
Rahul VaidyaRahul Vaidya
Senior Data Architect at Magellan HealthSenior Data Architect at Magellan Health
MARK KANGMARK KANG
Customer Service Associate at Magellan HealthCustomer Service Associate at Magellan Health
Kimberly M RowlandsKimberly M Rowlands
Certified Peer Support Specialist at Magellan HealthCertified Peer Support Specialist at Magellan Health