Juan Maximiliano Falcone
Specialty Contact Representative
Columbus
Summary
Dynamic professional with a robust background in customer service and administrative support, adept at managing high-volume calls and efficiently resolving issues. Recognized for exceptional collaboration skills and a results-driven approach in fast-paced environments, ensuring customer satisfaction at every interaction. Expertise as a Specialty Contact representative highlights a solid foundation in customer engagement and problem resolution, complemented by strong conflict resolution and communication abilities. Dependable and adaptable, consistently responding to changing needs with a proactive mindset.
Overview
7
7
years of professional experience
Work History
Contact Representative (Specialty Team)
Department of Veteran Affairs Veterans Health Administration
10.2023 - Current
- GS-0962-08 step 03
- Duties to include:
- Explains and advises the basis for payment decisions and reasons for disallowance.
- Explains payment methodologies used in adjudicating medical claims to resolve questions about allowable amounts and cost shares.
- Reviews and recommends approval or denial of preauthorization requests based on program guidelines, applicable laws and regulations.
- Assists in determining the status of claims for services. Redevelops claims for reprocessing, ensuring that all required information and documents are present and complete to facilitate payment of claims.
- Develops, examines, adjusts, reconsiders, recommends settlement of various types of claims, receives and processes requests for authorization of healthcare services, supplies and benefits.
- Assists in the development of systems and procedures for the management and processing of controlled and other priority communications.
- Assists with on-the-job training for newly appointed Customer Service Representatives as necessary or as directed by the Supervisor or Chief, CS.
Customer Service Representative (CSR)
Department of Veteran Affairs Veterans Health Administration
09.2019 - 10.2023
- GS-0962-08 step 01
- Experienced and reliable customer services representative with extensive experience aiding in a busy call center setting. Strong dedication to helping customers resolve issues and cultivating a positive image of organization. Excel in both team environment and alone. Proven ability to listen attentively, solve problems quickly and efficiently, and create high-quality professional relationship with callers. Fully committed to following company procedures while fulfilling customer needs.
Education
Bachelor of Science - Public Administration
University of Central Florida
Orlando, Florida01-2017
Skills
- Customer service expertise
- Strong verbal and written skills
- Analytical problem-solving
- Customer relationship management
- Effective complaint management
- Organizational efficiency
- Software proficiency
- Cross-functional collaboration
- Excel proficiency
- Skilled in formatting and editing with Microsoft Word
- Proficient in Windows
- Proficient in Microsoft Outlook
- PowerPoint proficiency
- Proficient in Microsoft OneNote
Data entry proficiency
Social perceptiveness
Empathy and patience
Goal oriented
Accomplishments
- Achieved consistent weekly call volume of 300+ customers.
- Maintained a 97% exceptional satisfaction rating over a 24-month period as a customer care representative.
- Quality Assurance (QA) average of 93%
- Achieved over 50 Kudos from customers.
- Managed multi-line phone system and effectively handled 100 tickets daily, contributing to a 60% increase in customer satisfaction.
Timeline
Contact Representative (Specialty Team)
Department of Veteran Affairs Veterans Health Administration
10.2023 - Current
Customer Service Representative (CSR)
Department of Veteran Affairs Veterans Health Administration
09.2019 - 10.2023
Bachelor of Science - Public Administration
University of Central Florida
Specialized Experience
- Ability to analyze and evaluate numerous and different types of documents submitted in support of inquiries, requests for pre-authorizations, reconsiderations, adverse credit situations and appeals.
- Ability to explain to inquirers what benefits are covered and how much is payable by program, and how much is the beneficiary cost share, if applicable.
- Processing and adjudicating claims for benefits.
- Operating a variety of office automation software, e.g., applications processing, spreadsheets, electronic mail, etc.
- Providing applicable statutes, in accordance with VA rules and regulations pertaining to assigned programs administered by the Intergrade Veterans Care in order to answer questions and resolve problems that are raised by authorized entities