Paola Hernandez
Houston,TX
Summary
Dynamic Customer Service Representative with a proven track record at United Healthcare, adept at problem-solving and conflict resolution. Skilled in regulatory compliance and call management, I consistently exceed performance benchmarks while delivering exceptional service. Known for effectively de-escalating customer concerns and maintaining professionalism in high-pressure situations. Empathetic professional in customer service known for high productivity and efficiency in task completion. Possess specialized skills in conflict resolution, data entry, and customer relationship management. Excel in communication, problem-solving, and adaptability, ensuring positive experiences and outcomes for customers.
Overview
3
3
years of professional experience
Work History
Customer Service Representative
United Healthcare
Houston, TX
10.2024 - 03.2025
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Explained eligibility details and affordability options to patients with kindness and respect.
- Assisted customers by phone and scheduled appointments and treatments.
- Investigated complaints regarding eligibility determinations or denials.
- Collaborated with other departments within the organization in order to resolve issues relating to Medicaid eligibility requirements.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Handled customer inquiries regarding insurance policy coverage details and payment status updates.
- Utilized computer technology to handle high volume of calls in a timely manner.
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Answered incoming customer calls regarding product inquiries, orders, complaints and general customer service.
Customer Service Representative
BC FORWARD For ACCENTURE
Houston, TX
02.2024 - 06.2024
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
- Researched and responded to inquiries from clients regarding Medicaid coverage and benefits.
- Reviewed medical documentation submitted by providers in order to determine whether services were medically necessary or appropriate for reimbursement under the program guidelines.
- Answered customer questions to maintain high satisfaction levels.
- Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.
- Updated customer accounts, addresses and contact information within call management databases.
- Engaged actively with callers, confirming or clarifying information and diffusing anger.
- Implemented basic troubleshooting and support techniques to enable speedy resolution of callers' issues.
Customer Service Cashier
airline apliances
Houston, TX
06.2023 - 01.2024
- Balanced cash drawers at the end of each shift.
- Processed efficient and accurate cash, check, debit and credit card payments using Point-of-Sale system.
- Maintained current knowledge of store promotions to highlight sales to customers.
- Operated cash registers to process payments for goods and services.
- Recommended, selected, located, and obtained products to meet customer needs.
- Built loyal clientele through friendly interactions and consistent appreciation.
- Maintained cleanliness of the checkout area by sweeping floors, emptying trash cans.
- Informed customers of in-store promotions or pricing specials.
Call Center Representative
mid atlantic finance company
Houston, TX
01.2022 - 03.2023
- Adhered to all company policies and procedures when dealing with customers.
- Updated customer accounts, addresses and contact information within call management databases.
- Provided excellent customer service to clients regarding billing inquiries.
- Investigated past due balances and determined payment plans as needed.
- Maintained records of customer interactions, transactions, comments and complaints.
- Greeted customers in a friendly and professional manner.
- Collaborated with other departments in order to resolve any outstanding customer issues.
Education
High School Diploma -
Sam Houston High School
Houston, TX06-2018
Skills
- Problem solving
- Customer service
- Regulatory compliance
- Call management
- Data entry
- Conflict resolution
- Appointment scheduling
- Communication skills
- Teamwork and collaboration
- De-escalation techniques
- Billing adjustments and refunds
- Inbound call management
- Complaint investigation
- Research
Affiliations
- bilingual both english and spanish
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
Timeline
Customer Service Representative
United Healthcare
10.2024 - 03.2025
Customer Service Representative
BC FORWARD For ACCENTURE
02.2024 - 06.2024
Customer Service Cashier
airline apliances
06.2023 - 01.2024
Call Center Representative
mid atlantic finance company
01.2022 - 03.2023
High School Diploma -
Sam Houston High School
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