Healthcare Customer Service Representative
Franny L Mosquea Prado
Concentrix
Lancaster,PA
2
years of professional experience
2
years of post-secondary education
Bilingual Healthcare Support Professional with practical nursing training and remote health plan expertise. Researched medical claim statuses, verified coverage and provider network participation, and documented findings to ensure timely follow-up. Delivered quality support for patient medical needs through insurance verification, appointment scheduling, and document organization while fostering effective communication and teamwork.
Work History
Healthcare Customer Service Representative
3 Months- Verified member eligibility, plan coverage, and cost-sharing using health plan systems and references to provide accurate information to members.
- Documented claim research, actions taken, and next steps in electronic case notes while escalating unresolved issues through established channels and ensuring member information protection under HIPAA.
- Researched medical claim status and reviewed claim records in ICUE, GPS, and History to identify issues for further investigation.
- Checked active provider contracts and network participation during research on coverage and cost-sharing questions.
- Review prior authorization and referral requirements and status, identify outstanding steps, and explain follow-up to members.
- UnitedHealthcare Account | Remote
Store Associate
2 MonthsLead Store Associate
9 Months- Maintained operational records and coordinated inventory counts while researching discrepancies with management to ensure accuracy in daily priorities.
- Maintained ALDI sales floor standards and organized product displays.
- Assisted customers with purchases, questions, and store directions.
- Operated register, processed payments, and balanced cash drawer.
Education
Practical Nursing Diploma - Nursing
Supervised Practical Nursing Clinical Rotation - Nursing
Skills
Medical Claims Research & Status Review | Electronic Case Documentation | Issue Escalation | Eligibility & Benefits Verification | Cost-Sharing Review | Provider Network Verification | Prior Authorization & Referral Status Review | HIPAA | Medical Terminology
Claims research
Eligibility verification
Prior authorization
Claim Denial Management
ICUE
GPS
History | Microsoft Excel
Word
and Outlook
SYSTEMS & LANGUAGES
English and Spanish
Personal Information
Title: MEDICAL CLAIMS SPECIALIST | CLAIMS RESEARCH & SUPPORT
Timeline
Healthcare Customer Service Representative
Concentrix
08.2026 - CurrentRead More
Store Associate
ALDI
06.2026 - 08.2026Read More
Lead Store Associate
ALDI
04.2025 - 01.2026Read More
Hospital Auxilio Mutuo
Supervised Practical Nursing Clinical Rotation from Nursing
11.2021 - 09.2022Read More
Antilles College of Health
Practical Nursing Diploma from Nursing
09.2021 - 09.2022Read More
Colegio De La Inmaculada Santurce
05.2021Read More