Leslie Rivera
Stewartsville,NJ
Summary
Dynamic and detail-oriented professional with a comprehensive background in customer service, administrative functions, and specialized expertise in Medicare claims management. Proven ability to excel in high-pressure environments, ensuring accuracy in financial transactions and delivering exceptional customer support. Possesses excellent communication and problem-solving skills with a track record of success in various roles.
Versatile professional serves as first point of contact for patients by verifying insurance, handling paperwork and preparing records. Patient-oriented and helpful candidate familiar with MS Office coupled with thorough knowledge of medical terminology. Committed to providing personalized service and quality patient care.
Overview
10
10
years of professional experience
Work History
Recovery Coordinator
BCBSSC
09.2023 - Current
- Distributed case files and assigned recovery claims to adjusters based on workload and case type.
- Maintained and analyzed detailed records for questionnaires, ROC06 claims, and caseloads.
- Investigated positive questionnaire responses and nursing department accident reports to support recovery opportunities.
- Opened and processed ITS and non-ITS ROC06 claims in compliance with internal and interplan protocols.
- Generated monthly and quarterly reports on claim assignments, cost containment savings, and overall performance metrics.
CSR II
Palmetto GBA/BCBS of SC
08.2023 - 09.2024
- Resolved complex issues by implementing creative problem-solving strategies.
- Processed insurance claims efficiently and accurately within specified timelines.
- Provided exceptional customer service by addressing inquiries and concerns in a timely and professional manner.
- Demonstrated extensive knowledge of Medicare guidelines and regulations.
- Performed various administrative duties to ensure smooth operations and compliance with organizational policies.
CSR II
Palmetto GBA/BCBS of SC
08.2023 - 09.2024
- Resolved complex issues by implementing creative problem-solving strategies.
- Processed insurance claims efficiently and accurately within specified timelines.
- Provided exceptional customer service by addressing inquiries and concerns in a timely and professional manner.
- Demonstrated extensive knowledge of Medicare guidelines and regulations.
- Performed various administrative duties to ensure smooth operations and compliance with organizational policies.
Night Auditor/Front Desk Agent
Woodspring Suites
03.2023 - 08.2023
- Provided exceptional customer service to ensure all guest needs were met and exceeded.
- Resolved issues and concerns promptly and effectively to enhance guest satisfaction.
- Managed room reservations and coordinated accommodations for incoming guests.
- Compiled and analyzed night audit reports to reconcile daily financial transactions.
- Facilitated smooth guest check-ins by efficiently managing registration and room assignments.
- Handled cash transactions accurately and securely in accordance with company policies.
BDC Representative
JON HALL CHEVROLET
11.2019 - 01.2023
- Provided exceptional sales support to the team by assisting with presentations and product demonstrations.
- Managed the CRM system to ensure accurate and up-to-date customer information.
- Made follow-up calls to clients to gather feedback and address any issues or concerns.
- Generated leads through strategic marketing efforts and networking within the industry.
- Communicated effectively with customers to provide product information and address inquiries.
- Scheduled appointments efficiently to optimize the sales team's productivity.
BDC Representative
JON HALL CHEVROLET
11.2019 - 01.2023
- Provided exceptional sales support to the team by assisting with presentations and product demonstrations.
- Managed the CRM system to ensure accurate and up-to-date customer information.
- Made follow-up calls to clients to gather feedback and address any issues or concerns.
- Generated leads through strategic marketing efforts and networking within the industry.
- Communicated effectively with customers to provide product information and address inquiries.
- Scheduled appointments efficiently to optimize the sales team's productivity.
Front End Supervisor
Winn-Dixie
11.2018 - 07.2022
- Oversee the daily operations of the front end department, ensuring efficient and smooth cashier transactions and customer service.
- Train, coach, and supervise front end staff, including cashiers and baggers, to ensure excellent customer service standards are met.
- Monitor cashier performance and provide feedback to improve productivity and accuracy.
- Ensure compliance with company policies and procedures, including cash handling and safety protocols.
- Manage cashier scheduling to ensure adequate coverage during peak hours and special events.
- Handle customer inquiries, complaints, and refunds in a professional and timely manner.
CSR II
First Citizens Bank
05.2015 - 02.2018
- Handled customer complaints with professionalism and a commitment to finding timely solutions.
- Resolved a variety of customer issues efficiently and to the satisfaction of all parties involved.
- Provided detailed account information to customers to support informed decision-making.
- Managed customer inquiries effectively, addressing concerns and providing accurate information.
- Answered phone calls promptly and courteously, assisting customers with their inquiries.
Education
AAS - Legal Studies
Post University
Skills
- Training facilitation
- Crisis management
- Teamwork
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Collaboration and teamwork
- Multitasking Abilities
- Adaptable and flexible
Timeline
Recovery Coordinator
BCBSSC
09.2023 - Current
CSR II
Palmetto GBA/BCBS of SC
08.2023 - 09.2024
CSR II
Palmetto GBA/BCBS of SC
08.2023 - 09.2024
Night Auditor/Front Desk Agent
Woodspring Suites
03.2023 - 08.2023
BDC Representative
JON HALL CHEVROLET
11.2019 - 01.2023
BDC Representative
JON HALL CHEVROLET
11.2019 - 01.2023
Front End Supervisor
Winn-Dixie
11.2018 - 07.2022
CSR II
First Citizens Bank
05.2015 - 02.2018
AAS - Legal Studies
Post University
Similar Profiles
Lekisha BrownLekisha Brown
Customer Service Advocate II at BCBSSCCustomer Service Advocate II at BCBSSC
India MilfordIndia Milford
Customer Service Representative Team Lead at BCBSSCCustomer Service Representative Team Lead at BCBSSC
LAKESHIA TERRELLLAKESHIA TERRELL
CSA III at Kelly Services / BCBSSCCSA III at Kelly Services / BCBSSC
Jason VegaJason Vega
Electrical Foreman at ClearcomElectrical Foreman at Clearcom
Dave Andre Cesario B. BawasantaDave Andre Cesario B. Bawasanta
United States Marine at Department of DefenseUnited States Marine at Department of Defense