Summary
Work History
Education
Skills
Timeline
CustomerServiceRepresentative

Magdalena Pimentel

Summary

Customer Service Representative with extensive experience in healthcare and insurance sectors, adept at resolving inquiries and ensuring customer satisfaction. Demonstrates strong analytical thinking and attention to detail, with a proven track record in enhancing operational efficiency and compliance. Bilingual and skilled in medical terminology, committed to fostering effective communication and delivering exceptional service.

Professional with strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Effective team collaborator, adaptable to changing needs, and consistently focused on achieving results through efficient and empathetic service. Known for reliability and proactive approach to meeting customer and organizational goals.

Work History

Customer service representative

La Care
  • Resolve member inquiries and issues efficiently, ensuring seamless service and satisfaction.
  • Guide members and providers through systems, enhancing user experience and accessibility.
  • Maintain compliance with HIPAA, safeguarding member information and privacy.
  • Document interactions in QMEIS, supporting data accuracy and service improvement.
  • Coordinate with internal and external parties, fostering effective communication and support.

Insurance Verification Specialist

Walgreens
  • Resolve PBM and insurance queries, enhancing customer satisfaction and operational efficiency.
  • Process PBM rejections and facilitate reimbursements, improving claim accuracy and timeliness.
  • Support specialized programs, providing expert guidance and boosting program effectiveness.
  • Document interactions and audit reports, ensuring data integrity and compliance.
  • Participate in projects, contributing to problem-solving and achieving measurable outcomes.

Customer service representative

Gainwell Technologies
  • Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area
  • Demonstrates knowledge and skill in assigned work processes
  • Develops understanding of the client's business and applies knowledge to support efficient procedures and adherence to service level agreements
  • Contributes to problem identification and resolution
  • Interprets, audits and reconciles reports for accuracy or completeness
  • Prepares and maintains standard reports for management and clients
  • Handles company confidential data according to policy and guidelines
  • Adheres to existing security policies and procedures.

Customer Service Representative

Medcore
  • Communicate with a diverse customer (member/provider/health plans) base, regarding individual questions and concerns specific to plan benefits, coverage determinations, event information, claims and complaints, conducts inquiries and research related to questions and concerns, including claims status and related information
  • Coordinates with others within and outside the organization to facilitate timely resolution of member, provider and health plan issues
  • Data entry of professional claims
  • Data entry of facility claims, Check source documents for accuracy
  • Verify data and correct data where necessary
  • Assist with daily provider correction reports
  • Maintains the confidentiality of patient and organization information at all times.

Education

High school diploma - General business occupation

Central Valley Opportunity Center
Modesto, CA
01.2015

Skills

  • Customer Service
  • Attention to Detail
  • Bilingual
  • Data Entry
  • Analytical Thinking
  • Prior Authorization Processing
  • Medical Terminology
  • Telephone Etiquette
  • Claims Processing
  • Problem Solving
  • Fast learner
  • Multi-Tasker
  • Insurance Verification
  • Medical office experience
  • Understanding of Medical Terms
  • Medicaid Knowledge
  • Coordination and Scheduling
  • Critical Thinking
  • Insurance Knowledge
  • Time Management

Timeline

Customer service representative

La Care

Insurance Verification Specialist

Walgreens

Customer service representative

Gainwell Technologies

Customer Service Representative

Medcore

High school diploma - General business occupation

Central Valley Opportunity Center

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Magdalena Pimentel