Summary
Overview
Work History
Education
Skills
Timeline
Generic

Karla Aguilar

Las Vegas,NV

Summary

Results-driven professional at Molina Healthcare with expertise in claims processing and conflict resolution. Demonstrated success in client engagement and regulatory compliance, improving service delivery and customer satisfaction. Skilled in navigating complex healthcare policies to deliver tailored solutions.

Overview

11
11
years of professional experience

Work History

Care Coordinator

FreedomCare
01.2024 - Current
  • Assess individual client needs through comprehensive evaluations and coordinate with healthcare professionals to develop personalized care plans
  • Facilitate access to healthcare services by scheduling appointments, arranging transportation, and ensuring clients understand their treatment options

Provider Claims Service Rep.

Molina Healthcare
03.2023 - 08.2023
  • Provides customer support and stellar service to meet the needs of our Molina members and providers
  • Resolves issues and addresses needs fairly and effectively, while demonstrating Molina values in their actions
  • Provides product and service information, and identifies opportunities to improve our member and provider experience
  • Relayed customer feedback to cross-functional teams to improve products and services
  • Asked probing questions and offered solutions to resolve customer issues
  • Responded to queries, solved or referred problems and followed up with clients to increase satisfaction
  • Navigated computer system to look up customer information and update policies
  • Handled billing related activities focused on medical specialties
  • Assisted claimants, providers and clients with problems or questions regarding claims

CSR- Service Desk Representative

Coin Cloud
04.2022 - 12.2022
  • Identifying and assessing clients' needs to achieve satisfaction
  • Resolving service problems by clarifying the client's inquiries; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution
  • Recommending potential products or services to management by collecting client information and analyzing client needs
  • Managing incoming calls
  • Building sustainable relationships of trust through open and interactive communication
  • Providing accurate, valid, and complete information by using the right methods/tools
  • Handling complaints, providing appropriate solutions and alternatives within the time limits, and following up to ensure prompt and effective resolution
  • Accurate documentation of client interactions
  • Following communication procedures, guidelines, and policies
  • Going the extra mile to engage clients
  • Resolving client complaints via phone, email, text, chat, or social media
  • Greeting clients professionally and identifying the problem(s) or reason(s) for calling
  • Acting as the company gatekeeper
  • Suggesting solutions to common client issues
  • Utilizing computer technology to handle high call volumes
  • Working with client support supervisors to ensure proper client support is being delivered
  • Responding to client queries in a timely and accurate way, via phone, email, or chat
  • Other duties as assigned

Intake Customer Representative

APPLEONE
04.2020 - 02.2021
  • Assisted client with intake process for Unemployment Compensation process; Notate and screen accounts accordingly
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations
  • Demonstrated excellent communication skills in resolving product and consumer complaints
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor
  • Fielded customer complaints and queries, fast-tracking for problem resolution
  • Answered incoming calls and emails, providing frontline customer support

High Risk Collections Associate

WYNDHAM DESTINATIONS
07.2015 - 02.2019
  • Notified customers of delinquent accounts with attempt to collect outstanding amounts
  • Advise clients of necessary actions and strategies for debt repayment
  • Skip trace delinquent customers to new addresses by inquiring at post offices, credit bureaus and telephone companies
  • Remained calm, stayed professional and provided exceptional service on calls, even when interacting with difficult individuals
  • Processed payments over phone and set up recurring drafts
  • Arranged for debt repayment and established repayment schedule based on customer finances
  • Recorded and updated customer personal accounts with accurate contact information
  • Reviewed accounts to determine payment plan compliance
  • Recorded information about customers' financial status and collections status efforts
  • Negotiated credit extensions to assist customers in paying overdue accounts
  • Completed skip traces on customers failing to respond to collection efforts

Financial Customer Service Representative

WYNDHAM VACATION RESORTS
01.2014 - 07.2015
  • Take inbound calls from owners inquiries regarding financial status of their accounts
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions
  • Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service
  • Asked probing questions to determine service needs and accurately input information into electronic systems
  • Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions
  • Mentored new employees on procedures and policies to maximize team performance

Education

HIGH SCHOOL DIPLOMA -

CENTRAL HIGH SCHOOL
LOS ANGELES, CA
06.2001

Skills

  • Client Evaluation Skills
  • Familiarity with Healthcare Policies
  • Resource Management and Allocation
  • Case Documentation
  • Data Reporting
  • Regulatory Compliance Expertise
  • Client Engagement
  • Payment System Administration
  • Understanding of Clinical Terminology
  • Claims processing
  • Effective Problem Solving
  • Conflict Resolution
  • Monitoring tools
  • Quality Assurance

Timeline

Care Coordinator

FreedomCare
01.2024 - Current

Provider Claims Service Rep.

Molina Healthcare
03.2023 - 08.2023

CSR- Service Desk Representative

Coin Cloud
04.2022 - 12.2022

Intake Customer Representative

APPLEONE
04.2020 - 02.2021

High Risk Collections Associate

WYNDHAM DESTINATIONS
07.2015 - 02.2019

Financial Customer Service Representative

WYNDHAM VACATION RESORTS
01.2014 - 07.2015

HIGH SCHOOL DIPLOMA -

CENTRAL HIGH SCHOOL

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Karla Aguilar