JANIRA GARCIA
Victorville
Summary
Medicare specialist with experience in member services also offering a background of financial asset management. Experienced with managing provider relations and addressing inquiries effectively. Utilizes communication and problem-solving skills to ensure seamless interactions between providers and healthcare organizations. Compassionate and efficient professional with an in-depth knowledge of medical terminology and HIPAA regulations. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Provider Services Representative
UnitedHealth Group - Ear Care Professionals
04.2024 - Current
- Acted as a liaison for hearing providers, addressing inquiries regarding benefits, eligibility, claims authorizations, and payments.
- Utilized UHC's portals and EDI tools to manage referrals, check claim status, submit prior authorizations, and verify member benefits.
- Resolve provider inquiries and complaints on the first call, and document interactions to identify recurring problems.
- Built sustainable relationships and trust with provider offices using open and interactive communication.
- Handle patient registrations, confirm coverage, process hearing aid orders, and manage payment collection for out-of-pocket costs.
- Performed data entry tasks accurately and efficiently to update customer accounts in the system.
Medicare & Retirement Representative
UnitedHealth Group
06.2023 - 04.2024
- Improved client satisfaction by providing exceptional retirement planning services and financial advice.
- Streamlined the enrollment process for new members, resulting in improved customer experience.
- Navigated complex software systems to efficiently access member information and complete tasks promptly.
- Contact care providers office on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance.
- Remote
Bank Teller
Citibank
11.2021 - 07.2022
- Established trust with clients by maintaining confidentiality and protecting sensitive financial information.
- Conducted daily audits of cash drawer, ensuring accuracy and compliance with bank policies.
- Educated customers on banking products, enabling them to make informed decisions about their finances.
- Increased efficiency within the teller line by sharing best practices among colleagues, leading to shorter wait times for customers.
Client Service Representative
H&R Block
01.2014 - 04.2021
- Provided exceptional customer service during peak tax season by remaining calm under pressure and addressing client concerns promptly and professionally.
- Built strong rapport with clients through clear communication and regular updates on the status of their tax filings.
- Engaged in community marketing events and insured that clients understood the offered services.
- Developed strong relationships with clients through proactive outreach and regular check-ins on progress and satisfaction.
Education
High School Diploma -
Susan Miller Dorsey Senior High School
Los Angeles, CA05.2011
Skills
- Medical Terminology Knowledge
- Call Center Operations
- Customer Account Management
- Retirement Claim & Appeal Assistance
- Client Relationship Building
- Database Management
- Enrollment & Benefits Planning
- HIPAA Compliance
- Financial Transactions
- Insurance verification
- Provider relations
- Issue and complaint resolution
- LiveChat Messaging
Certification
UHG: Medicare & Retirement Certified Foundation 1 & 2
LANGUAGES
English - Native or Bilingual
Spanish - Native or Bilingual
Timeline
Provider Services Representative
UnitedHealth Group - Ear Care Professionals
04.2024 - Current
Medicare & Retirement Representative
UnitedHealth Group
06.2023 - 04.2024
Bank Teller
Citibank
11.2021 - 07.2022
Client Service Representative
H&R Block
01.2014 - 04.2021
High School Diploma -
Susan Miller Dorsey Senior High School