Jessica Villanueva
TTEC
New Caney,TX
8
years of professional experience
Highly qualified bilingual, customer focused professional with several years of successful experience in positions of increasing responsibility and duties. Operates with a strong sense of urgency and thrives in a fast paced environment. Seeking a challenging and stimulating position which offers plenty of scope for initiative and career advancement.
Work History
Senior Chat Representative
2 Years 1 Month- Delivered exceptional customer service through live chat, resolving inquiries efficiently and effectively.
- Collaborated with cross-functional teams to enhance user experience and streamline communication processes.
- Analyzed customer feedback to identify trends and recommend improvements for service delivery.
- Implemented quality assurance measures to ensure consistency in responses and adherence to company standards.
- Monitored chat performance metrics, providing insights for continuous improvement initiatives.
- Reduced waiting time for customers by consistently meeting or exceeding established response time goals.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Evaluated medical claims for compliance with policy guidelines and regulatory standards.
- Collaborated with healthcare providers to resolve discrepancies in claims processing.
- Analyzed dental claims to ensure compliance with policies and regulations.
- Achieved cost savings by identifying fraudulent or abusive billing patterns through meticulous analysis of claim data.
Claims Resolution Coordinator
3 Years 5 Months- Examined and processed paper claims and/or electronic claims determining whether to return, pend, deny or pay claims within policies.
- Followed established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues.
- Settled claims with claimants in accordance with policy provisions and compared claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim.
- Interacted with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.
- Maintained a 98% accuracy rate for 10+ months and developed internal auditing policies and procedures that reduced errors by over 40% over 18 months.
- Analyzed claims to determine extent of patients insurance liability, review and negotiate settlements with claimants insurance policy provisions.
Help Desk Representative
1 Year 9 Months- Provided technical support through remote access tools to resolve internal end user issues and achieve first call resolution.
- Monitored and responded quickly and effectively to tickets, calls, chats, or in-person service requests.
- Interacted with end users via soft phone or chat modules to resolve software and hardware issues.
- Utilized Service Now as the ticketing tool to track and escalate tickets for end users.
- Managed assigned pharmacy workstations and tasks while supporting team members in promptly, safely and accurately documenting patient prescriptions.
- Entered data on the internal system and filed HIPAA compliant documents, doctor's orders, and control substances.
Live Chat Agent
2 Years 10 Months- Guided customers through their online experience via chat and/or email sessions.
- Promptly assess customer needs and proactively provide solutions.
- Effectively and routinely balanced multiple customers through multiple chat sessions at one time.
- Drive repeat business by providing excellent service, accurate and thorough product and service knowledge to customers and through relationship building with customers.
- Kept customers informed on the status of their services, reconciled errors in a cost effective manner, resolved post-order issues such as returns and followed up to ensure all customer needs were fulfilled.
- Met or exceeded scorecard requirements for productivity, schedule adherence, quality and attendance.
- Completed assignments accurately despite a large workload.
Education
High School Diploma
Skills
Communicative
Time Management and Collaboration
Bank Procedures
Record-Keeping and Scheduling
Strategic
Critical Thinking and Complaint Resolution
Software Programs
Claims Resolution and Data Analysis
ZenDesk
Payment Processing and Proficient in Technology
Claims review
Claims
ICD-10 coding skills
ICD codes
Timeline
Senior Chat Representative
Cigna
08.2024 - CurrentRead More
Claims Resolution Coordinator
TTEC
04.2023 - CurrentRead More
Help Desk Representative
Alorica
05.2021 - 02.2023Read More
Live Chat Agent
T-Mobile
08.2018 - 06.2021Read More
Cleveland High School
High School Diploma
Read More