Jose Baires
Queens,NY
Summary
Driven professional with a proven track record in customer service and issue resolution. Excelled in high-volume environments, achieving top-tier customer satisfaction through expert handling of financial transactions and complaint resolution. Skilled in leveraging customer support skills to enhance operational efficiency and participant experience.
Overview
9
9
years of professional experience
Work History
MEMBER SERVICE REPRESENTATIVE
32 BJ Health Funds
08.2017 - 11.2023
- Collecting and analyzing data/information to resolve a problem in real time, at high volume standards.
- Provide customer service to participants to resolve eligibility or Fund benefit issues. Displayed proficiency in all processing systems: eligibility process, Health benefits and system, COOL/V3/DYNAMICS system, CRM/WF and vendor systems.
- Displayed proficiency in all Funds (Health, Pension, Legal, SRSP, Shortman). Handling of inquiries through vendors, Medical, Optical, Pharmacy, Dental and Employee Assistance.
- Follow workflows to resolve participant questions.
- Representatives analyze and interpret customer phone and written correspondence.
- Ongoing management of own inventory of work accumulated through Participant interactions/inquiries. These inquiries will involve customer complaints or inquiries on eligibility, enrollment, benefits and claims, and Pension related issues.
- Operating computers with multiple information screens to research and resolve customer inquiries on line.
- Representatives ensure that all processing meets or exceeds MSR Quality measurement objective and performance standards, including, but not limited to, handling and documentation. Ability to effectively communicate to Participants.
- Perform any other relevant, related or pertinent work or duties as requested or assigned.
Team Leader Member Services
Maximus State Of Health Marketplace
10.2014 - 08.2017
- Coordinate unit call center operations and activities
- Monitor performance and provide feedback and coaching of staff to improve performance (perform QC evaluations) Manage inbound and outbound calls that are routine in nature, answer inquiries by clarifying information; researching, locating, and providing relevant information
- Follow procedures and scripts, using fundamental knowledge to navigate information systems and/or CRM system(s)
- Assist team members in maintaining and collecting sensitive case documents to ensure service level standards are met, or exceeded; and monitor the training and process needs of staff to support customer needs
- Work with Call Center Supervisor to schedule and organize personnel to effectively monitor call center coverage and production meets or exceeds quality standards
- Meet Quality Assurance, production requirements, and other key performance metrics
- Support and enforce call center expectations as well as departmental and corporate policies and procedures
- Be proficient in all activities and job functions of Administrator I and II and be able to handle any issues that arise from either group.
- May assist in the processes required for medical case file creation; including but not limited to data entry and records management, orphan and return mail, replying to emails.
- Listen attentively to customer needs and concerns; demonstrate empathy. /
- Track and escalate case issues, as needed Performs other duties as may be assigned by management - Bilingual.
- Collecting and analyzing data/information to resolve a problem in real time, at high volume standards.
- Provide customer service to participants to resolve eligibility or Fund benefit issues Displayed proficiency in all processing systems: eligibility process, Health benefits and system, COOL/V3 system, CRM/WF and vendor systems Displayed proficiency in all Funds (Health, Pension, Legal, SRSP, Shortman)
- Handling of inquiries through vendors, Medical, Optical, Pharmacy, Dental and Employee Assistance Follow workflows to resolve participant questions
- Representatives analyze and interpret customer phone and written correspondence Ongoing management of own inventory of work accumulated through Participant interactions/inquiries These inquiries will involve customer complaints or inquiries on eligibility, enrollment, benefits and claims, and Pension related issues Operating computers with multiple information screens to research and resolve customer inquiries on line
- Representatives ensure that all processing meets or exceeds MSR Quality measurement objective and performance standards, including, but not limited to, handling and documentation Outreaches for Haste inquiries.
CONSUMER SERVICES SPECIALIST IV- Member Services
Maximus State Of Health Marketplace
10.2014 - 08.2017
- Respond to customer inquiries received by telephone, Interactive Voice Response (IVR), or web based portal regarding information on programs and services
- Record customer interactions and transactions, by documenting details of inquiries, complaints, comments, and actions taken
- Follow standard operating procedures to ensure consistency and accuracy
- Address customers inquiries and resolve problems to ensure that appropriate changes are made
- Refer unresolved customer grievances to designated departments for further investigation
- Communicate with supervisor regarding any potential needs or concerns
- Perform data entry accurately Respond to customer inquiries made via telephone & Web Chat tool including handling multiple chat sessions at a time in a prompt, professional and friendly manner.
Education
Associate Degree in Criminal Justice - Criminal Justice
ASA College
Brooklyn, NY05.2014
Skills
Customer Service
Financial Transactions
Customer Support
Pension application
Call center experience
Issue Resolution
Escalation Handling
Complaint Handling
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
MEMBER SERVICE REPRESENTATIVE
32 BJ Health Funds
08.2017 - 11.2023
Team Leader Member Services
Maximus State Of Health Marketplace
10.2014 - 08.2017
CONSUMER SERVICES SPECIALIST IV- Member Services
Maximus State Of Health Marketplace
10.2014 - 08.2017
Associate Degree in Criminal Justice - Criminal Justice
ASA College