Gema Carranza

Assisted clients/visitors/patients with the completion and submission of the ACCESS (Automated Community Connection to Economic Self-Sufficiency) applications for Food Stamps, Medical Assistance, and Temporary Cash Assistance and Medicare Savings Program.

Provided access and referrals for other community agencies. Completed the DCF (Department of Children and Families) and Community Medical Group consent forms on-line.

Explained the advantages of becoming a member of Community Medical Group to our customers. Participated in Community events with the goal to obatin leads for possible enrollments with CMG Clinics.

Assisted clients in creating a “My ACCESS Account” Follows up daily on the ACCESS application until the Office of Economic Self-Sufficiency determines their eligibility.

Trained and supervised new employees to promote overall team productivity and consistent service.
Handled escalated calls and escalated issues for members providers and other internal departments to preserve customer satisfaction and maintain long-term business.
Monitors operations to ensure adherence to service level standards and company/department policies and procedures.
Ensures adequate phone coverage including making decisions regarding scheduling changes.
Oversees one or more teams of customer service associates who handle customer service inquiries and problems via phone.
Evaluates the quality of customer service associates’ calls from customers and provides feedback to associates on strengths and areas for improvement.
Monitor the day-to-day activities of the call center.
Work with management team to support employees and maximize customer satisfaction.
Ensure daily policies and procedures are being adhered to continuously.
Motivate call center employees to focus on excellent patient satisfaction by handling complaints, answering questions, and scheduling patients.
Measure performance with key metrics such as call abandonment, calls waiting and service levels.
Ensure adherence to policies for attendance, established procedures.

Trainer for the Customer Service Department, provided training to new hires.

As a Customer Service Team Lead I provide support and lead a team to provide excellent five star customer service to members and providers. Demonstrates ability to coach, mentor, develop and influence to improve the quality and accuracy of each member interaction. Provide Support Service to Managers in leading and motivating a team of service associates in performance, productivity, and growth opportunities. Ensure timely resolution of complex issues and escalated cases. Assist phone lines when business needs require support. Assist in hiring and onboarding new employees. Provide advice and guidance based on audit findings and deliver performance feedback to associates as outlined in business unit's policies and procedures. Administer learning lab training to new hires to exceed goals as quickly as possible. Manage new hires nesting to bridge the gap from the training room into integration with the Team. Use goals, reports, and direct observation to provide one-on-one coaching to improve performance. Review materials for instructor-led and online training and facilitates classroom or virtual training for topics including business process changes, projects, products, and systems.

As a Member Service Representative answer incoming calls from members and providers assisting with Eligibility, Benefit information Enrollment, Authorizations and Claims Status. Provided support on Special Outbound Projects such as LEP Late Enrollment Penalty, COB Coordination of Benefits and Retention. Assisted with complex and escalated calls from members and providers.

As a Bilingual Member Service Rep answered an average of 75-80 calls per day assisting members and providers with Eligibility, Enrollment, Authorizations and claims status including answering subscribers questions and concerns in reference to their health plan and payments. Transfered calls to the appropriate Departmet to further assist member. Assisted providers with eligibility and claims status. Also, worked as a walk-in Representative assisting members with Grievance and appeals process and processing payments.

Managed high call volume with tact and professionalism. Effectively managed a high-volume of inbound and outbound customer calls. Recorded all leads from outbound telephone marketing. Directed calls to the appropriate individuals and departments.