Hermitssa Alvarez
Loveland,CO
Summary
An analytical problem-solver with outstanding communication skills, I am a detail-oriented team player possessing strong organizational abilities. With four years of remote experience, that can manage multiple projects simultaneously with high accuracy. Proficient in insurance policies, practices, and standards, I am seeking an opportunity to leverage these strengths and contribute to the company's success.
Overview
9
9
years of professional experience
Work History
Claims Representative/Issue Resolution Team Rep.
Anthem BCBS/Elevance Health
11.2021 - Current
- Conducted thorough reviews, extensive research, meticulous analysis, and reprocessing of claims in a fast-paced environment for both providers and members.
- Managed approximately 50 inbound/outbound calls per day with customers.
- Utilized investigative techniques to address and resolve member issues, ensuring a satisfactory resolution.
- Provided exceptional customer service to policyholders, addressing concerns and answering questions throughout the claims process.
- Efficiently resolved approximately 30 escalated calls from members/providers and addressed post-call survey complaints, all while upholding a professional and amiable demeanor.
- Continuously coached agents to enhance their understanding of the latest processes and procedures.
- Develop and implement strategies to improve customer satisfaction and loyalty through effective issue resolution
- Initiate and participate in cross-functional meetings to identify areas of improvement in customer care processes and procedures, and provide recommendations for enhancements
- Identify trends and patterns in customer issues and provide recommendations for process improvements
- Facilitate training sessions for new hires to ensure a smooth transition and understanding of customer care processes and procedures
- Assist in the development and implementation of strategies to improve the efficiency and effectiveness of the Issue Resolution Team, resulting in faster and more satisfactory resolutions for members.
- Consistently met performance metrics such as quality scores and case closure rates, demonstrating commitment to excellence in handling customer grievances.
- Provided continuous training and support to agents, improving team efficiency and skill levels.
- Improved customer satisfaction rates by providing timely and empathetic responses to appeals inquiries.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Educated clients accurately on health insurance coverage and benefits, updated records, and coordinated benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Customer Service Representative Call Center
Maximus Federal Inc.
08.2020 - 02.2021
- Responding to numerous phone inquiries
- Maintained a positive, empathetic, and professional attitude toward consumers
- Acknowledging and resolving customers complaints
- Processing orders, forms, and applications request
- Ensure customer satisfaction and provide professional support
- Ensure compliance with all applicable federal and state laws and regulations in customer interactions
- Ensure accurate documentation and record keeping of all customer interactions.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Offered advice and assistance to customers, paying attention to special needs or wants.
Home Health CNA
Steadfast Caregivers
06.2015 - 08.2020
- Improved patient satisfaction by actively listening and addressing concerns or requests promptly.
- Conducted regular vital signs checks, monitoring patients'' conditions and reporting any changes to medical staff.
- Enhanced patient comfort by providing compassionate and attentive care.
- Maintained accurate records of patients'' progress, appointments, and medications for efficient care coordination among healthcare providers.
- Increased patient safety by conducting regular safety assessments of the home environment and suggesting modifications when necessary.
- Facilitated communication between patients, families, and healthcare providers to ensure all parties were informed of care plans and progress updates.
Education
Vocational - Nursing Assistance
JMB Nursing Assistant Training
Far Rockaway, NY04.2015
High School Diploma -
Reading High School
Reading, PA06.2012
Skills
- Proficient in Data Entry/Analysis
- Completing daily electronic call logs
- Call Center Operations
- Creating and maintaining files
- Proficient in Spanish
- Strong team and leadership skills
- Proficient in Microsoft Word, Excel, and Outlook
- Sales experience
- Excellent communication and listening skills
- Research and analysis
- Problem-solving
- Leadership
- Customer service
- Insurance Claims Review
- Claims Investigation/Processing/Adjustment
- Medicaid knowledge
- Attention to Detail
- Critical Thinking
- Records Management
- Patient contact
- Medical Terminology knowledge
- Policy understanding
- Problem Resolution
- Complaint Handling/Resolution
- Customer Data Confidentiality
- Dependable and Responsible
- HIPAA Compliance
- Work prioritization
- Time management
Accomplishments
- Supervised team of 20 staff members.
- Played a pivotal role as one of the founding agents of the East Region Issue Resolution Team, leveraging exceptional service and problem solving skills to enhance member and provider experience
- As a customer service representative, I sustained an exceptional 98.9% member satisfaction rating for a period of over 24 months, demonstrating a consistent provision of outstanding service.
- Surpassed performance review expectations for the years 2022 and 2023 in the current role.
- Documented and resolved 25-30 daily escalations, leading to outstanding results in post-call surveys.
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Claims Representative/Issue Resolution Team Rep.
Anthem BCBS/Elevance Health
11.2021 - Current
Customer Service Representative Call Center
Maximus Federal Inc.
08.2020 - 02.2021
Home Health CNA
Steadfast Caregivers
06.2015 - 08.2020
Vocational - Nursing Assistance
JMB Nursing Assistant Training
High School Diploma -
Reading High School
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