Monica Jaramillo
Miami,FL
Summary
Driven to promote customer satisfaction through personalized and knowledgeable support for different requirements. Self-directed in investigating and resolving inquiries. Demonstrated skills in meeting and surpassing productivity targets. Experienced call center professional trained in insurance policies, plans and coverage limitations. Remains calm and level-headed in fast-paced environments. Solves problems independently and teaches providers to use electronic systems. High-performing and systematic with excellent organizational and analytical abilities with focus on promoting loyalty. Gifted communicator, conflict manager and relationship builder successful at offering providers positive and seamless experiences. Hardworking, conscientious and resourceful team player. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience.
Overview
6
6
years of professional experience
Work History
System Configuration Administrator
Independent Living Systems LLC
Doral, FL
11.2022 - 02.2024
- Assisted in the development of new administrative systems, procedures and policies.
- Prepared reports on various projects for management review.
- Developed spreadsheets to track project progress, budgets and other related data.
- Conducted research on requested topics using reliable sources.
- Ensured that all paperwork was completed accurately before submission deadlines.
- Designed forms and templates to streamline workflow processes within the organization.
- Researched and developed administrative policies, procedures and guidelines to facilitate operations.
- Maintained positive working relationship with fellow staff and management.
- Utilized document management system to organize company files, keeping up-to-date and easily accessible data.
Provider Relations Coordinator
Independant Living systems LLC
Doral, FL
11.2021 - 10.2022
- Managed provider data updates, including contact information and credentialing status.
- Developed and maintained relationships with providers to ensure compliance with contractual obligations.
- Coordinated provider network meetings, events and trainings.
- Reviewed and processed new provider applications.
- Conducted regular outreach activities to promote services offered by the organization.
- Resolved provider inquiries and issues related to reimbursement, claims processing and other operational matters.
- Communicated changes in policies and procedures to providers as needed.
- Provided technical assistance to providers regarding electronic transactions such as claims submission or payment inquiry requests.
- Compiled monthly activity reports detailing progress achieved towards objectives set forth in the contract agreement.
- Tracked regulatory changes that may affect provider relations processes or protocols.
- Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues.
- Investigated concerns such as billing and claims questions on behalf of providers.
Claims Representative
Independent Living Systems LLC
Doral, FL
10.2019 - 11.2021
- Filed appeals on behalf of customers when necessary after denial of a claim due to insufficient evidence.
- Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
- Conducted research into medical terminology related to healthcare claims processing activities.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
- Investigated facts, confirmed coverage and liability, negotiated settlements, and determined payments for claims.
- Provided clear explanations of benefits, eligibility requirements, and applicable laws when communicating with customers.
Call Center Representative
Independent Living Systems LLC
Doral, FL
07.2018 - 10.2019
- Investigated and documented claims to determine eligibility for coverage.
- Obtained medical records, bills, and other related documents to process claims.
- Researched policy provisions and applicable laws to verify coverage under policies.
- Assessed the validity of claims based on established criteria and procedures.
- Reviewed claims denials for accuracy prior to issuing final decisions.
- Advised clients on claim status updates as well as their rights and responsibilities under their policies.
- Ensured compliance with all relevant regulations governing the processing of claims.
- Processed appeals in a timely manner according to company standards.
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Performed outbound calling campaigns to promote new products or services.
- Provided accurate information regarding products and services while upselling additional products when appropriate.
- Assisted customers with navigating the company's website to locate desired information or items for purchase.
- Analyzed data collected during each call in order to identify trends in customer feedback.
- Resolved customer complaints in a timely manner to ensure customer satisfaction.
- Performed follow-up calls as necessary to ensure satisfactory resolution of customer inquiries.
- Utilized knowledge base to answer inquiries from customers quickly and effectively.
- Maintained high levels of professionalism while interacting with customers via phone or email.
- Developed effective working relationships with team members across multiple departments.
Education
High School Diploma -
Fairfax Senior High School
Los Angeles, CA06.1987
General Studies
LACC
Los Angeles, CASkills
- Account Development and Networking
- Claims Reviewing
- Claims Resolution
- Billing Discrepancy
- Client Relationship Management
- Microsoft Office
- Event Logistics
- Customer Service
- Team Collaboration
- Events Coordination
Languages
Spanish
Native/ Bilingual
Timeline
System Configuration Administrator
Independent Living Systems LLC
11.2022 - 02.2024
Provider Relations Coordinator
Independant Living systems LLC
11.2021 - 10.2022
Claims Representative
Independent Living Systems LLC
10.2019 - 11.2021
Call Center Representative
Independent Living Systems LLC
07.2018 - 10.2019
High School Diploma -
Fairfax Senior High School
General Studies
LACC
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