MARK FLORES
Cleveland,OH
Summary
Dedicated support specialist with a strong background in claims processing and technical troubleshooting. Proven track record in multi-channel communication, effectively guiding customers through complex issues and enhancing overall satisfaction by simplifying intricate information for better understanding.
Overview
1
1
Certification
30
30
years of professional experience
Work History
Error Processing Representative
Sonora Quest Laboratories
Phoenix, AZ
12.2020 - 06.2026
- Resolved missing or incorrect claim information, enhancing support for internal teams.
- Communicated clearly with cross-department partners to ensure accurate claim handling.
- Maintained high accuracy while managing 200+ items daily in a fast-paced environment.
- Assisted departments with complex claim issues, maintaining patience and clarity for effective communication.
Member Services Representative
PracticeMojo
Phoenix, AZ
06.2019 - 04.2020
- Provided customer support via phone, email, and chat, achieving performance goals consistently.
- Trained new clients on website editing and customization to improve user confidence.
- Executed site edits and implemented widgets and semi-custom design changes to elevate customer satisfaction.
- Advised clients on website navigation and usability to optimize their customization experience.
Claims Representative Associate
UnitedHealthcare
Phoenix, AZ
01.2018 - 05.2019
- Handled specialized claim types with high attention to detail, ensuring accurate communication and clarity for customers.
- Assisted members and providers with claim questions and resolved issues to enhance understanding of benefits.
- Simplified complex insurance information into clear language to improve customer comprehension.
- Resolved discrepancies by researching multiple systems and communicating findings professionally.
Customer Care Representative II
Isagenix
Gilbert, AZ
05.2017 - 12.2017
- Delivered exceptional customer service via phone, chat, and email, fostering positive customer relationships.
- Resolved routine to complex inquiries with empathy and professionalism, enhancing customer satisfaction.
- Provided technical support for account access, enrollment, and order fulfillment.
- Educated customers on policies, products, and services, empowering them to minimize future issues.
Claims / Customer Care Representative
Medical Mutual of Ohio
Strongsville, OH
02.2015 - 06.2016
- Processed dental claims efficiently while ensuring accuracy, minimizing delays in reimbursement.
- Assisted providers and members with benefit inquiries, claim status updates, and eligibility verification to enhance service experience.
- Completed follow-ups and ordered ID cards, resolving returned information requests to maintain member satisfaction.
Billing Representative
DentalOne Partners
Independence, OH
04.2012 - 02.2015
- Addressed unpaid claims through effective communication with payers and offices, facilitating prompt resolutions.
- Took ownership of claims until resolution, prioritizing customer satisfaction throughout the process.
- Assisted patients and dental offices with billing inquiries and insurance issues, enhancing overall understanding.
Police Officer
City of Cleveland
Cleveland, OH
08.1996 - 11.2011
- De-escalated volatile encounters with calm communication and empathy.
- Utilized exceptional interpersonal skills to assist the public during stressful situations, fostering trust and support.
- Provided clear explanations, gathered information, and guided individuals through difficult moments.
- Cultivated strong community relationships through consistent, respectful public service, enhancing community engagement and cooperation.
Education
Professional Medical Coding Curriculum Certificate -
Cuyahoga Community College
Cleveland, OH10-2011
Skills
- Claim Processing
- Technical Troubleshooting
- Customer Support
- Account Management
- Multi-channel communication
- Workflow Navigation
- Problem resolution
- Cross-Functional Collaboration
Certification
- Medical Coding Certification
- First Aid Certification
- Adult & Child CPR
Timeline
Error Processing Representative
Sonora Quest Laboratories
12.2020 - 06.2026
Member Services Representative
PracticeMojo
06.2019 - 04.2020
Claims Representative Associate
UnitedHealthcare
01.2018 - 05.2019
Customer Care Representative II
Isagenix
05.2017 - 12.2017
Claims / Customer Care Representative
Medical Mutual of Ohio
02.2015 - 06.2016
Billing Representative
DentalOne Partners
04.2012 - 02.2015
Police Officer
City of Cleveland
08.1996 - 11.2011
Professional Medical Coding Curriculum Certificate -
Cuyahoga Community College