Karina Calva
Palmetto,FL
Summary
Dedicated health care advocate with expertise in insurance review, patient education, and customer service. Proven ability to address member needs and facilitate healthcare access, ensuring compliance and satisfaction.
Overview
12
12
years of professional experience
Work History
Health Care Advocate
CarePlus Health Plans
Louisville, Kentucky
10.2023 - Current
- Helped patients review insurance coverage options and understand benefits.
- Escalated unresolved and pending customer grievances for follow-up.
- Addressed member needs, answered complex benefit questions, resolved issues, and provided education.
- Documented inquiry, comment, complaint, transaction, and interaction details, then took appropriate action.
- Helped members schedule appointments and arrange transportation.
- Assisted members with outreach to primary care offices for authorizations or referrals.
- Completed callback lists for members regarding primary care provider network changes and assigned new primary care providers.
- Supported outbound team with daily email lists, reviewed applicability, entered data into Excel, verified accuracy, and returned completed information for upload.
- Adhere to departmental policies, compliance requirements, and performance standards.
Customer Care Representative
Transamerica Life Insurance Company
Clearwater, Florida
01.2019 - 10.2023
- Process loan requests, explain loan defaults, and review repayment options for each participant.
- Educate participants on available withdrawal types, tax withholding, early withdrawal penalties, and 1099-R timing based on plan rules.
- Update contribution amounts by phone, explain pretax and Roth options, review employer matching rules, and guide participants through hardship withdrawal or loan paperwork to reduce form errors, denial time, and investment restrictions or fees.
Customer Care Representative
Crius Energy
Clearwater, Florida
12.2015 - 01.2019
- - Managed Spanish- and English-language customer inquiries through inbound and outbound call support.
- Delivered service resolutions while handling payment processing, invoice review, and billing clarification.
- Supported enrollment processing and service request fulfillment.
- Expanded operational coverage through cross-training across multiple departments based on company needs.
- Supported service delivery across multiple states to maintain consistent customer assistance.
- Reviewed contract terms, early termination fees, and disclosure documents to support accurate customer understanding.
- Educated consumers on deregulated market structure, service options, and credit check requirements.
Healthcare Recruiter
Hill Top Research
St. Petersburg, Florida
12.2014 - 11.2015
- Received and checked in English- and Spanish-speaking participants for personal healthcare and pharmacokinetic (PK) studies.
Entered confidential information into databases and software systems, including Client HIX, Hill-Card, and Oracle.
Pre-screened study participants in person and by phone to assess eligibility for upcoming client studies through review of personal and medical information.
Provided instructions to participants before and during study phases.
Coordinated with staff and participants to schedule study appointments.
Supported receptionist duties by answering inquiries, signing out checks, paging employees, and returning calls.
Education
High School Diploma -
Clearwater High
Clearwater, FL05-2015
Skills
- Insurance review
- Patient advocacy
- Compliance adherence
- Benefits education
- Data documentation
- Customer relationship management
Timeline
Health Care Advocate
CarePlus Health Plans
10.2023 - Current
Customer Care Representative
Transamerica Life Insurance Company
01.2019 - 10.2023
Customer Care Representative
Crius Energy
12.2015 - 01.2019
Healthcare Recruiter
Hill Top Research
12.2014 - 11.2015
High School Diploma -
Clearwater High