Lauren Gonzales
Houston,PA
Summary
As a Customer Service Representative (CSR), I ensures final resolution of each customer inquiry is done in a timely and courteous manner. I document detailed information relevant to the client. Some resolutions may require research and/or contacting an expert in other areas of the company. Although, some encounters may require multiple interactions, as the CSR I strive to maintain the company goal of "First Time Resolution" whenever possible.
Overview
6
6
years of professional experience
Work History
Member Service Representative
AETNA Better Health of PA/MD
Houston, TX
11.2020 - Current
- Provided support to members regarding account inquiries, processing transactions, and resolving issues.
- Answered incoming calls regarding membership benefits and services.
- Handled customer complaints in an efficient and courteous manner.
- Adhered to all applicable policies, procedures, regulations, and laws.
Claims Analysts
MedRisk
King Of Prussia, PA
10.2019 - 11.2020
- Reviewed customer claims, identified discrepancies and determined appropriate course of action.
- Conducted investigations to gather evidence in support of claims resolution.
- Assessed medical records for coverage eligibility and benefit accuracy.
- Developed strategies for resolving complex claims issues.
Benefits Analyst
Conduent
Cherry Hill, NJ
07.2018 - 10.2019
- Provided guidance and advice to employees regarding their benefits packages.
- Administered employee insurance, pension and savings plans, working with insurance brokers and plan carriers.
- Kept operations in compliance with requirements by applying knowledge of applicable regulations, legal statutes and tax code information.
- Updated and reconciled retirement, tax and health care accounts.
- Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
- Provided assistance to plan participants by explaining benefits information to ensure educated selections.
Education
High School Diploma -
Philadelphia High School For Girls
Philadelphia, PA01-2015
Skills
- Computer Literacy/Microsoft Office
- Customer Resolutions
- Customer Assistance
- Enrollment And Claims Procedures
- Independent Worker and Thinker
- Effective Written And Verbal Communication
- Detailed-Oriented
Timeline
Member Service Representative
AETNA Better Health of PA/MD
11.2020 - Current
Claims Analysts
MedRisk
10.2019 - 11.2020
Benefits Analyst
Conduent
07.2018 - 10.2019
High School Diploma -
Philadelphia High School For Girls