Leticia Lopez

• Serve as the primary point of contact for complex client, employer group, broker, and internal account issues.
• Research, analyze, and resolve high-profile claims, eligibility, benefits, and billing concerns while ensuring timely resolution.
• Build and maintain strong working relationships with internal departments, employer groups, brokers, and account management teams.
• Partner with Sales, Claims, Care Management, Pharmacy, and Utilization Management to resolve escalated client concerns.
• Interpret health plan benefits, policies, and contractual provisions to provide accurate guidance and recommendations.
• Coordinate resolution of complex service issues while maintaining exceptional customer satisfaction.
• Mentor and support teammates by sharing subject matter expertise, coaching on processes, and assisting with complicated cases.
• Prepare detailed documentation, communicate updates to stakeholders and ensure follow-through until resolution.
• Effectively manage complexting priorities while consistently meeting quality and productivity standards.

• Managed high-volume customer inquiries, ensuring timely and accurate responses to enhance satisfaction.
• Resolved complex issues by collaborating with cross-functional teams, improving service delivery processes.
• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Interpreted and responded to correspondence.
• Keyed, reviewed, and processed claims.

July 1997