Nilda Pina
Toms River,NJ
Summary
Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Customer Service Representative
- Handles incoming calls or inquiries from prospective customers or clients
- Assists customers effectively by solving customer disputes
- Provide customer with additional information or explain service
- Discuss products offered and ensure customer satisfaction, resolving complex issues
- Authorized to work in US for any employer
Bilingual Customer Service Representative
LEA Leading Edge Administrator LLC
Tampa, FL
08.2016 - 02.2022
- Responsible for client Inquiries for Health insurance plans
- Educate external clients on self-service options, and functions
- Actively engage with team to develop and improve best practice procedures
- Maintains focus on achieving positive outcome for constituents and company
- Ability to triage and manage multiple priorities, balance all concerns with day-to- day activities and work with minimal supervision
- Use of different network via navigation work from Home
- Healthcare Call Center Specialists resolved customers service or billing complaints by performing activities with correction or updates such with adjusting bills
- Contact customers to respond and refer unresolved customer grievances to designated departments for further investigation
- Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken
- Actively engage with team to develop and improve best practice procedures
- Maintains focus on achieving positive outcome for constituents and company
- Resolve calls related issues, products, and/or system applications delivery matters
- Review claims via use of different network.
- Resolved concerns with products or services to help with retention and drive sales
- Performed support ticket transaction resolution tasks and administrative functions
- Identified and responded to customer requests and concerns through email, online chat and phone for both English and [Type]-speaking customers
- Maintained and managed customer files and databases
- Updated and maintained information in customer accounts
- Helped improve customer satisfaction by translating customer paperwork and company documentation
- Initiated outbound calls to respond to inquiries and to follow-up with previous contacts
- Achieved outstanding ratings on Email Handle Time (EHT), Chat Handle Time (CHT), Phone Handle Time (PHT) and Quality and Voice of Customer (VOC)
- Communicated with management when customer issues escalated and worked to find resolutions
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates
HEDIS Operations Coordinator
United Health Care
Tampa, FL
01.2016 - 05.2016
- Manages various data organized within Excel spreadsheets, separated and combine PDF medical records in Adobe Acrobat
- Conducts claims research, determining correct service location or verifying member history
- Requests medical records and performs follow up of requests within HEDIS database tool
- Follow all HIPAA requirements
- Resolved problems, improved operations and provided exceptional service
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting
- Worked with customers to understand needs and provide excellent service
- Completed paperwork, recognizing discrepancies and promptly addressing for resolution
- Conducted research, gathered information from multiple sources and presented results
- Proved successful working within tight deadlines and fast-paced atmosphere
HEDIS Project Coordinator
Molina HealthCare
Tampa, FL
10.2015 - 12.2015
- Outreach members and assist with coordination by setting wellness exams appointment
- Assist Member with the changes for a new PCP that accommodate member's needs
- Educate members of the importance of seeing provider on a regular basis as a preventative service measure and others
Health consultant
The CSI Companies, Inc
Tampa, FL
05.2014 - 08.2014
- Operations function responds to inquiries and outreach members while providing accurate information regarding their new plan with Medicaid
- Mail the member welcome package, ID card, and updated member demographic
- Manage workloads, Prioritize tasks, and met deadlines.
Customer Service Rep Associate
Humana Health Insurance
Tampa, FL
01.2007 - 10.2010
- Customer Care Specialist Medicare/Medicaid at Call Operations.
- customer service experience with analyzing and solving customer problem by provided guidance that
- Multi Task, with different applications, and able to learn new and complex computer system.
- Review member Medicare/Medicaid eligibility and updated the information through Customer care.
- Billing & Enrollment provided pharmacies, claims, premiums, liability.
- Provided help to clients, answered call's assisted clients with changes
- Maintained up-to-date knowledge of customer accounts
- Explained products and benefits
- Handled (8 +) calls per hours a day to address customer inquiries and concerns.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Learned new skills and applied to daily tasks to improve efficiency and productivity.
- Led projects and analyzed data to identify opportunities for improvement.
Education
High school diploma - General Administration
undefined
Franklin K Lane High School
Certificate in Medical Assistant Medical billing Microsoft Office Professional - undefined
Performance Training Inc
2004
Skills
- Data Entry and Maintenance
- POS Systems and Ordering Platforms
- Customer Retention Strategies
- Call Documentation
- Courteous with Strong Service Mindset
- Understanding Customer Needs
- Calm and Professional Under Pressure
Certification
Insurance Verification
HIPAA
Recognition of Outstanding member service (10+ years)
Languages
Spanish - Expert
Additional Information
Medical Assistant Medical billing Microsoft Office-professional
Languages
Spanish
Native or Bilingual
Timeline
Bilingual Customer Service Representative
LEA Leading Edge Administrator LLC
08.2016 - 02.2022
HEDIS Operations Coordinator
United Health Care
01.2016 - 05.2016
HEDIS Project Coordinator
Molina HealthCare
10.2015 - 12.2015
Health consultant
The CSI Companies, Inc
05.2014 - 08.2014
Customer Service Rep Associate
Humana Health Insurance
01.2007 - 10.2010
Customer Service Representative
High school diploma - General Administration
undefined
Franklin K Lane High School
Certificate in Medical Assistant Medical billing Microsoft Office Professional - undefined
Performance Training Inc
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