Marco Esquivel

• Responded to 75 to 100 customer requests for products, services and company information.
• Answered customer telephone calls promptly to avoid on-hold wait times.
• Initiated outbound customer calls to review policy reviews and late payments to avoid lapse in coverage.
• Collected premiums and issued accurate receipts.
• Presented insurance options to customers in order to close sales on new policies.
• Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
• Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.

• Assessed customer account information to determine current issues and potential solutions.
• Responded to 40 - 50 daily customer inquiries to drive highest level of customer service and develop and continually enhance relationships.
• Provided password resets, order life cycle and status, order resolution, order/shipment fulfillment and order/shipment replacement.
• Responsible for agreement eligibility and balances, profile master and maintenance, personal and unit production and compensation, career path and compensation, director programs, contest and promotions.
• Interface with other Service Reps, Service Coordinators, Specialist, Analysts, and Service Center Management to provide information on service feedback.

• Worked with Medicare/Medicaid State Programs, Star Plus, Star Kids, Star and IChip.
• Used different systems such as; Facets, Macess, Excel Spreadsheets, Word and Care Compass.
• Document/Communicate, answered 40 to 50 calls and routed task assignments to IHSC, FSC and Managers on different department issues.
• Agency changes, Appeals/Denials/LTSS/Medical, Assisted Living, Authorization Status Inquiries, Benefit Inquiries and DAHS.
• Interpreted/language Spanish request, MOW, MTP, NEMT, PAS request increase, PCP/Specialist lookup, Pest Control request, pharmacy info, Refax/LTXX/Medical, Respite Hours.

• Assist 70 to 80 providers and members with claims and benefits/eligibility cases on QNXT, Emdeon, RX Claims systems.
• Assist commercial line with promising members on benefits of enrolling on CHS Starplus.
• Communicate verbally and written with other departments such Service Coordination, Pharmacy, UM, and Claims Dept.
• Upheld strict standards for quality and performance.

Healthspring

• Set pre-certification cases for 60 - 80 members with PPO, POS networks on Alineo, Careplanner Web system.
• Research pre-certifications and eligibility with Blue Chip, Word and other spreadsheet specifications.
• Provided benefits and eligibility to providers and members on Blue Star and Feliqs system.
• Routed cases to nurses or other company departments for admission approvals.
• Interpret bilingual callers on pre-certifications setup, and benefits/eligibility calls.