Juan Santana
Summary
Bilingual (English/Spanish) healthcare and customer service professional with over 10 years of experience supporting members in complex benefits, claims, and eligibility environments. Strong background in research coverage details, documenting accurate member information, and ensuring compliance with HIPAA and payer guidelines. Consistently maintains high quality standards (95%+) and excels in detail-oriented, analytical roles supporting claims accuracy and coordination of benefits.
Overview
2026
2026
years of professional experience
Work History
Advocate4Me Representative Sr
United Healthcare
10.2023 - Current
- Support members with complex healthcare benefits, claims, eligibility, and coverage inquiries.
- Research insurance coverage details to help determine appropriate benefit coordination, and next steps.
- Educate members on plan rules, coordination of benefits requirements, and coverage responsibilities.
- Document member interactions accurately across multiple systems to support claims processing and resolution.
- Maintain strict HIPPA compliance while handling sensitive health and insurance information.
- Consistently achieve quality scores above 95%, demonstrating accuracy, compliance, and attention to detail.
Bank Teller
Wells Fargo
03.2020 - 10.2023
- Processed financial transactions with a high degree of accuracy and regulatory compliance.
- Reviewed account details and documentation to ensure correctness, and prevent errors.
- Identify discrepancies, and resolve issues efficiently while maintaining confidentiality.
- Build trust with customers through clear communication, and attention to detail.
Customer Service Representative
Denny's Corp, Olive Garden, Forever 21
2011 - 2020
- Delivered high-volume customer support while maintaining accuracy and service standards.
- Managed transactions, documentation, and operational procedures in fast-paced environments.
- Developed strong attention to detail, time management, and problem-solving skills.
Education
High School Diploma -
Option Secondary School Sails
Chula Vista, CASkills
- Claims research and resolution
- Coordination of benefits (COB) support
- Benefits and eligibility verification
- Primary vs secondary coverage identification
- HIPAA and regulatory compliance
- Data accuracy and documentation
- Member and provider communication
- Microsoft Excel, Word, and PowerPoint
- Bilingual: English and Spanish
Timeline
Advocate4Me Representative Sr
United Healthcare
10.2023 - Current
Bank Teller
Wells Fargo
03.2020 - 10.2023
Customer Service Representative
Denny's Corp, Olive Garden, Forever 21
2011 - 2020
High School Diploma -
Option Secondary School Sails