Open To Work
Karla Marcellus
El Anexo Stream Lab
Orlando,FL
Work Preference
Job Search Status:
Open to work
Desired Job Title
Patient Service RepresentativePatient Account RepresentativeMember Service RepresentativeMember Advocate
Minimum Desired Compensation
$45000/yr
14
Years of experience
Results-driven customer service advocate with bilingual proficiency and a focus on enhancing member experience. Skilled in resolving complex inquiries and streamlining operational processes. Aiming to utilize healthcare knowledge to support organizational goals and improve service delivery.
Work History
Operations Coordinator
5 Months- Oversaw daily operational activities to maintain optimal workflow and facilitate on-time project completion.
- Coordinated project schedules, emphasizing task prioritization to achieve deadline adherence.
- Coordinated resource allocation and information dissemination to enhance team members' effectiveness on ongoing projects.
- Identified and implemented targeted process improvements, streamlining operations and reducing bottlenecks.
- Oversaw studio planning and infrastructure development, optimizing physical production layouts and coordinating technical assets.
- Analyzed operational data to identify trends and support strategic decision-making initiatives.
Member Experience Associate
2 Months- Monitored and applied company procedures, regulatory protocols, and benefit structures to guarantee 100% compliance and accuracy in all interactions.
- Streamlined inquiry handling processes to achieve a high first-contact resolution (FCR) rate, ensuring compliance with and exceeding departmental service-level agreements (SLAs).
- Captured and organized detailed caller requests in real time, maintaining rigorous precision and adherence to established corporate protocols.
- Administered updates and management of sensitive demographic data and communication preferences, adhering to established policies for secure profile maintenance.
- Resolved billing discrepancies by collaborating with Independent Physician Associations (IPAs) to facilitate accurate rebilling for beneficiaries.
- Assessed beneficiary benefits in real time to identify care gaps, connecting individuals with essential healthcare campaigns and resources.
Customer Care Representative Part D
5 Months- Maintained a daily call volume of 10-15 calls with a 95%+ call accuracy rate
- Processed beneficiaries' requests for new prescriptions, refills, renewals, and benefit overrides in accordance with each plan sponsor's guidelines and recommendations.
- Investigated beneficiaries' grievances and logged them in the quality system software for escalation and quality management to improve compliance and communication.
- Engaged with beneficiaries to support their healthcare needs by discussing new plan offers and transferring them to specialized departments for medically related inquiries.
Claims Analyst
1 Month- Reviewed and assessed intricate patient accounts to identify payment variances, ensuring accuracy through contract details, account notes, and insurance communications.
- Analyzed and reconciled substantial volumes of EOBs and RAs with patient ledgers to ensure accurate financial balancing and compliance.
- Formulated appeal letters and patient requests, streamlining communication with insurance providers to resolve financial discrepancies.
- Engaged with insurance representatives through targeted inquiries to clarify denial justifications, improving claim processing.
- Collaborated with team members to streamline claims processing workflows
- Analyzed claims data to identify discrepancies and ensure compliance with policies
Customer Relationship Advocate
8 Months- Appointed to an intensive, corporate-sponsored training track, dedicating half of each shift to mastering FINRA Series 7 and Series 63 competencies, including options, debt instruments, and regulatory compliance.
- Handled daily queue of 15+ complex inquiries, resolving retail client issues related to balance checks, security positions, and stock status updates.
- Assessed customer investment profiles for suitability to align with financial goals and risk tolerance.
- Implemented verification standards for sensitive inquiries, account security resets, and demographic profile updates to enhance account security.
Licensed Health Insurance Agent
1 Month- Executed daily management of 20+ outbound member engagement calls, fostering a helpful and empathetic communication style.
- Managed appointment scheduling to facilitate seamless consumer transitions, focusing on consultative engagement.
- Ensured accurate documentation of member interactions and qualifications in tracking system, facilitating compliance with regulatory requirements.
Bilingual Customer Service Representative
4 Months- Executed daily management of 30+ calls to address and resolve subrogation account issues for Scio Health Analytics.
- Reviewed and interpreted injury claims, ensuring adherence to state and federal regulations while evaluating liability and recovery options.
- Provided comprehensive bilingual support, effectively resolving customer issues and boosting satisfaction.
- Analyzed injury claims for liability and recovery potential, focusing on compliance with state and federal regulations.
- Facilitated improved first-contact resolution rates through detailed data analysis and the simplification of complex injury claims for claims specialists.
Customer Advisor
5 Months- Maintained high efficiency by managing a high-volume queue of 70–85 customer calls daily while upholding quality standards.
- Secured protected health information (PHI) by strictly verifying HIPAA data to locate accounts accurately.
- Streamlined dispute resolution by routing billing errors, duplicate charges, and appeals to specialized departments, reducing customer wait time.
- Optimized revenue cycles through timely updates of insurance information and proactive negotiation of customer payments, enhancing cash flow.
- Managed high-volume documentation by analyzing, processing, and indexing critical correspondence using CWF workflow systems, ensuring compliance and accuracy.
Licensed Health Insurance Agent
2 Months- Facilitated efficient management of 15–20 inbound calls each day, prioritizing customer satisfaction for Florida Blue.
- Leveraged market insights to close 2–5 sales daily, ensuring alignment with established performance benchmarks.
- Analyzed and resolved challenging web and product inquiries, improving the overall effectiveness of insurance consultations.
- Analyzed client needs and executed targeted sales strategies to provide optimal insurance coverage options.
Spanish Tutor
2 Months- Executed specialized laboratory sessions tailored to professors' curricula, fostering deeper comprehension of advanced course topics.
- Designed and implemented focused tutoring sessions to assist students in mastering complex assignments and comprehending course content.
- Orchestrated dynamic workshops and extracurricular sessions, significantly fostering student interest and involvement in language studies.
- Managed administrative responsibilities in partnership with professors and lab manager to optimize lab efficiency and support departmental objectives.
- Crafted specialized study aids aimed at optimizing student understanding and readiness for assessments.
Spanish Tutor
1 Year 2 Months- Executed specialized laboratory sessions that supported professors' teaching objectives and deepened students' comprehension of challenging concepts.
- Designed and implemented focused tutoring sessions to support students in mastering complex assignments and comprehending course content.
- Orchestrated dynamic workshops and extracurricular sessions that significantly elevated student involvement with the language.
- Managed administrative responsibilities in partnership with professors and lab manager to optimize lab efficiency and support departmental objectives.
- Crafted personalized educational resources aimed at optimizing student readiness for assessments.
Education
Bachelor of Science - Healthcare Administration
- 3.8 GPA
- Relevant Coursework: o Essentials of Managed Care, Insurance & Managed Care, Mechanisms of Insurance & Reimbursement in Managed Care, Healthcare Finance, and Medical Law & Ethics.
- Professional Development: Managed Care & Certified Specialist Payment & Reimbursement (CSPR)
- President's List Summer 2026
Associate of Science - Medical Office Administration
- 3.57 GPA
- President's List for Summer 2020
- Relevant courses: Keyboarding, Introduction to Billing and Coding, Patient Privacy, Pathophysiology & Pharmacology, and Insurance Claims, Processing & Adjudication.
- Professional Development: Certified Medical Administrative Assistant (CMAA)
Skills
EOB analysis
Payment coordination
Healthcare reimbursement knowledge
HIPAA management
Account activity documentation
Microsoft Office proficiency
Bilingual customer service
Project management
Process implementation
Timeline
Operations Coordinator
El Anexo Stream Lab
05.2026 - CurrentRead More
Member Experience Associate
Alignment Healthcare
10.2024 - 12.2024Read More
Customer Care Representative Part D
CVS Health
08.2023 - 01.2024Read More
Claims Analyst
CorroHealth
01.2023 - 02.2023Read More
Customer Relationship Advocate
Fidelity Investments
01.2022 - 09.2022Read More
Licensed Health Insurance Agent
Alliance and Associates
09.2019 - 10.2019Read More
Bilingual Customer Service Representative
Randstad
02.2019 - 06.2019Read More
Customer Advisor
Parallon
01.2018 - 06.2018Read More
Licensed Health Insurance Agent
Interactive Resources
09.2017 - 11.2017Read More
Spanish Tutor
Florida State College at Jacksonville
06.2014 - 08.2014Read More
Spanish Tutor
Florida State College at Jacksonville
08.2012 - 10.2013Read More
Herzing University
Bachelor of Science from Healthcare Administration
Read More
Herzing University
Associate of Science from Medical Office Administration
Read More