Lauren Betancourt
Selma,TX
Summary
Dedicated professional with a strong background in data analysis, customer support, and attention to detail. Seeking to leverage detail-oriented problem-solving and communication skills within a appeal position
Overview
17
17
years of professional experience
Work History
Claims Benefit Specialist
Aetna
05.2018 - Current
- Analyzed claims data to ensure adherence to company policies and regulatory compliance.
- Reviewed and processed benefit claims efficiently, maintaining accuracy in all transactions.
- Collaborated with cross-functional teams to resolve complex claim issues and improve service delivery.
- Trained new team members on claims processing systems and best practices for efficiency.
- High dollar claim processor that assist with CBP/hospital bulk EX claims over 25k, IR claims, CHP, High dollar ECHS, SS2 claims
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Assisted in the development of department goals and objectives, actively working towards achieving them through individual performance metrics tracking efforts.
- High dollar SME for new hires/new hire classes
Member Engagement Representative
Aetna
05.2018 - 08.2018
- Streamlined onboarding processes for new members, improving retention rates and member experience.
- Analyzed member feedback data to identify trends and recommend service improvements.
- Collaborated with cross-functional teams to develop targeted outreach strategies for increased member participation.
- Improved overall member experience with thorough product knowledge and personalized recommendations.
Medicare Customer Service Representative
Aetna
05.2016 - 05.2018
- Resolved complex Medicare inquiries, ensuring customer satisfaction and compliance with regulatory guidelines.
- Provided accurate information on benefits, eligibility, and claims processing to diverse customer base.
- Assisted in training new team members on system navigation and best practices for customer interactions.
- Streamlined processes for handling member concerns, resulting in improved response times and efficiency.
- Managed a high volume of inbound calls, adeptly navigating multiple systems while maintaining focus on customer needs.
Customer Service Representative
Medix
01.2015 - 05.2016
- Responsible for making one hundred to one hundred fifty outbound calls per day to members of CVS Caremark to enroll and educate on prescription benefits available under health insurance plan such as ninety day prescription refills, automatic refills, and verifying if member had any questions about medications.
Mortgage Customer Service
Wells Fargo
12.2011 - 11.2014
- Duties included taking fifty to one hundred inbound calls from Wells Fargo Mortgage customer and answering questions regarding property taxes, homeowners insurance, billing and statements, taking payments via check by phone, setting up automatic payments, and cross sale bank products and services such as refinances and home equity loans.
Customer Care Consultant
AFNI
06.2009 - 12.2011
- Provided telephone customer service by giving Verizon door to door business agents quotes on Verizon business services. I applied developing knowledge of Verizon services and customer account information. Utilized established procedures to carry out routine work duties as well as seeking guidance from team members to resolve issues and identify appropriate issues for escalation. Identifying the best package for the business customer and providing the products appropriate for that particular customer.
Education
High School Diploma -
James Madison High School
San Antonio, Texas05.2007
Business Administration
San Antonio College
San Antonio, TexasSkills
- Great communication and customer service skills
- Outstanding skills in relationship building
- Proficient in computer software
- QWERTY keyboard 60 words per minute
- Problem solving
- Time management
- Attention to detail
Timeline
Claims Benefit Specialist
Aetna
05.2018 - Current
Member Engagement Representative
Aetna
05.2018 - 08.2018
Medicare Customer Service Representative
Aetna
05.2016 - 05.2018
Customer Service Representative
Medix
01.2015 - 05.2016
Mortgage Customer Service
Wells Fargo
12.2011 - 11.2014
Customer Care Consultant
AFNI
06.2009 - 12.2011
High School Diploma -
James Madison High School
Business Administration
San Antonio College