Jazmin Rivera
San Juan,USA
Summary
Professional with strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Effective team collaborator, adaptable to changing needs, and consistently focused on achieving results through efficient and empathetic service. Known for reliability and proactive approach to meeting customer and organizational goals.
Overview
7
7
years of professional experience
Work History
Provider Enrollment Department
Qualfon - Gainwell
09.2025 - 10.2025
- Handled provider inquiries regarding renewal of license and enrollment processing applications
- Assisted with provider correspondence and enrollment applications
- Coordinated between departments
- ELMMIS - Interchange
- DOH License website
- Contract
Member Service Representative
HUMANA
09.2024 - 09.2025
- Resolved patient inquiries and concerns, ensuring timely and accurate information delivery.
- Educated patients on insurance benefits, coverage options, and billing inquiries for improved understanding.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company''s database.
- Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
- Delivered exceptional support during high call volume periods by maintaining composure and professionalism under pressure.
Medical Billing Specialist
Walgreens
01.2023 - 09.2024
- Processed Medicaid and managed care claims for pharmacy and hospital services
- Reviewed RX images, verified refills, and resolved third-party claim rejections
- Supported prior authorizations and assisted with ICD-10 medical coding
- Remote
Overnight Customer Service Representative
Faneuil
01.2021 - 01.2023
- Handled after-hours resident CRISIS calls for Sandy Springs, GA
- Provided crisis and emotional support for distressed callers
- Managed dispatch communications for public safety and court services
Member Service Representative / Team Lead
Orlando Family Physicians
01.2019 - 09.2021
- Led team handling live chat, calls, and emails for OFP
- Scheduling patient appointments
- Answering incoming calls / Making outbound calls
- Confirming patient appointments
- Verifying insurances
- Checking on referrals and authorizations
- Three way with insurance and patients
Education
Associate's Degree - Culinary
Valencia College
Online01-2019
High School Diploma - undefined
Liberty High School
Kissimmee, FL05.2013
Skills
- Customer Service & Call Center Operations
- Medical Billing & Claims Processing (Medicaid/Medicare) FLMMIS
- ICD-9 / ICD-10 Coding, EMR Systems, HIPAA Compliance
- Technical Support, Data Entry (10 years), CRM Tools (Salesforce, Zendesk)
- Bilingual: English & Spanish
- Microsoft Office Suite (Word, Excel, Outlook, Teams, Access) OneNote
- Leadership & Team Supervision
- Zoom
- Kronos
- UKG / ADP
- FLMMIS
- DOH
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Provider Enrollment Department
Qualfon - Gainwell
09.2025 - 10.2025
Member Service Representative
HUMANA
09.2024 - 09.2025
Medical Billing Specialist
Walgreens
01.2023 - 09.2024
Overnight Customer Service Representative
Faneuil
01.2021 - 01.2023
Member Service Representative / Team Lead
Orlando Family Physicians
01.2019 - 09.2021
High School Diploma - undefined
Liberty High School
Associate's Degree - Culinary
Valencia College