MARIA GOMEZ
Aetna, a CVS Health
Madera,CA
1
Language
12
years of professional experience
Customer-focused professional with extensive experience in customer service, relationship management, and problem resolution. Demonstrated ability to manage challenging situations through effective communication, conflict resolution, and critical thinking. Strong team collaborator who adapts quickly to changing business needs while consistently delivering exceptional service, customer satisfaction, and organizational results. Recognized for reliability, empathy, and a proactive approach to achieving goals and supporting team success.
Work History
Customer Service Representative
2 Years 3 Months- Resolved member inquiries efficiently, enhancing overall satisfaction and support experience.
- Provided bilingual support to customers, resolving inquiries and enhancing satisfaction levels.
- Trained new staff on company policies, procedures, and customer service best practices to ensure consistency.
- Resolved member complaints with empathy, resulting in increased loyalty and repeat business.
- Resolved member inquiries regarding insurance eligibility and benefits with accuracy.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Managed difficult conversations with compassion and professionalism; helping deescalate tense situations while maintaining a focus on finding resolutions.
- Developed strong relationships with members by providing empathetic support and understanding during challenging health situations.
Compliance & Risk Specialist
3 Years 2 Months- Reviewed Group policies and standards, creating gap analysis and impact assessments, creating and implementing operational controls and process enhancements to ensure compliance.
- Established internal controls and processes to support compliance through project management and engagement of key stakeholders.
- Partnered with Leadership and Operation teams to develop procedures and business unit controls around processes.
- Organized training procedures to educate staff on benefits and consequences of compliance and non-compliance with regulations.
- Streamline and revised policy procedures to improve bottom-line for general operation of compliance program.
- Organized training procedures to educate company staff on benefits and consequences of complying or defying regulations.
- Streamlined and revised policy procedures to improve bottom-line for general operation of compliance program.
- Prepared and presented organized stakeholder conferences.
- Developed and maintained successful relationships with industry leaders.
Reputation Management Specialist
1 Year 8 Months- Oversaw all social media site activity for multiple business lines to include tracking and responding to comments.
- Responded with a sense of urgency to all escalated complaints: Better Business Bureau (BBB) and Consumer Financial Protection Bureau (CFPB).
- Exceed in finding the root cause of complaints and de-escalating clients who have filed regulatory complaints against Freedom Debt Relief (FDR).
- Oversaw social media activity across multiple business lines, tracking and responding to client comments to enhance brand reputation.
- Proactively identify, reach out and respond to questions or concerns from internal and external clients.
- Collaborate with various departments to identify root cause of escalated issues.
- Delivered subject matter expertise to resolve client issues effectively.
- Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Recognized as Subject Matter Expert in newly developed reputation management program, providing insights and best practices to enhance client engagement.
Customer Service Advocate
8 Months- Resolved customer issues with knowledgeable, friendly service, enhancing overall satisfaction.
- Answered inbound calls and emails, providing frontline customer support or assistance with product and service transactions.
- Provided frontline customer support for Debt Resolution Program clients.
- Building relationships with clients that impact the success of the Debt Resolution Program.
- Exceeded company productivity standards on consistent basis with a one call resolution.
- Supported team initiatives by sharing knowledge and resources., providing support and knowledge to support overall customer experience and team goals.
- Built strong relationships with customers, contributing to business development through effective product knowledge.
Loan Advisor
7 Months- Delivered customer service to assist clients in managing loan obligations during unexpected financial challenges.
- Guided customers through their loan and documentation.
- Presented excellent customer service to customers who need assistance in meeting their loan contract obligations, due to unexpected financial situations.
- Guided clients through loan processes and documentation, ensuring understanding and compliance.
- Reviewed loan agreements to verify completeness and accuracy according to applicable policies.
- Performed Outbound Collection calls or via e-mail with customers who are delinquent in their vehicle loan.
- Monitored risk accounts daily, weekly, and monthly, ensuring timely collection of debit/credit card payments.
- Achieved production goals through adherence to company policies, by following all policy procedures.
Administrative Assistant/ Sales Purchasing
11 Months- Supervised all job contracts: assigned each technician, responded to customer requests, created new work orders, and payrolls.
- Verified, log in dates, and deadlines for each job contract.
- Maintained customer accounting and followed up on current/past due invoices.
- Prepared a weekly excel sheet of our Open Order Equipment for management, salespeople, and each department to track down the status of each job.
- Contributed to office meetings by sharing insights and updates on projects.
- Participated with leadership/office meetings.
Medical Office Assistant
1 Year 6 Months- Provided administrative support to medical staff, including scheduling patient appointments and managing physician calendars.
- Performed data entry of patient information into electronic health records system.
- Answered and directed incoming calls in a professional manner.
- Investigated insurance claims, reviewed coverage and liability, and prepared comprehensive reports to recommend payment or denial of claims.
- Conducted interviews with claimants, witnesses, and medical professionals to gather critical information for claims assessment.
- Assisted colleagues with difficult cases; provided guidance regarding complex issues or scenarios.
- Performed special projects upon request from management; completed tasks efficiently while meeting deadlines.
- Worked collaboratively with team members across multiple departments; identified areas where processes could be improved.
- Analyzed trends in claim denials and delays to pinpoint improvement opportunities, enhancing overall claims processing efficiency.
Education
High School Diploma
Skills
Regulatory Compliance & Policy Adherence
Insurance Policy Knowledge & Administration
Quality Assurance & Performance Monitoring
Customer Engagement & Relationship Management
Process Improvement & Operational Efficiency
Training Facilitation & Knowledge Transfer
Results-Driven Performance
Operations Management & Workflow Coordination
Strategic Decision-Making
Customer Compliance & Regulatory Requirements
Issue Resolution & Escalation Management
Case Management & Documentation
New Hire Onboarding & Staff Development
Accomplishments
- Led Team Chacon with the highest ACE score of 101%, exceeding performance expectations and quality standards.
- Selected by Team Leadership to support the Mentor and Escalations Department, providing guidance and assistance in resolving complex member issues.
- Selected by Team Leadership as a Subject Matter Expert (SME) for new hire training, providing support, knowledge sharing, and guidance to help new employees succeed.
- Recognized with the Serving with Heart Certification for demonstrating outstanding customer service, empathy, and commitment to member satisfaction.
- Selected as a Subject Matter Expert (SME) to partner with stakeholders on the Evergreen Project, providing operational expertise and process insights..
- Consistently completed knowledge articles with a high degree of accuracy and efficiency, ensuring reliable and up-to-date information for team members.
- Earned the Employee of the Month Award for documenting, analyzing, and improving business processes to support operational excellence and continuous improvement.
- Resolved product issues by conducting consumer testing, analyzing feedback, and implementing effective solutions.
Languages
Spanish
Full Professional
References
References available upon request.
Timeline
Customer Service Representative
Aetna, a CVS Health
05.2024 - CurrentRead More
Compliance & Risk Specialist
Achieve
11.2019 - 01.2023Read More
Reputation Management Specialist
Achieve
03.2018 - 11.2019Read More
Customer Service Advocate
Achieve
07.2017 - 03.2018Read More
Loan Advisor
Bridgecrest
08.2016 - 03.2017Read More
Administrative Assistant/ Sales Purchasing
California Boiler
10.2015 - 09.2016Read More
Medical Office Assistant
Planned Parenthood Mar Monte
06.2014 - 12.2015Read More
Kingsburg High School
High School Diploma
Read More