Summary
Overview
Work History
Education
Skills
Timeline
Generic

Ramon Lugo Jr

Tampa,FL

Summary

Inbound contact representative with extensive experience in claims processing and Medicaid eligibility at Humana. Proven track record of delivering exceptional customer service and achieving first call resolution. Skilled in Microsoft Office and relationship management, ensuring efficient support and satisfaction for members and providers.

Overview

13
13
years of professional experience

Work History

Inbound Contact Representative 2/Long Term Care Florida Medicaid

Humana
Tampa, FL
2005.10 - 2019.03
  • Take incoming calls from provider who have questions about claims status and reprocessing if needed.
  • Take incoming calls from members about benefits, eligibility status, and services of the LTC program.
  • Represents the company by addressing incoming telephone, digital, or written inquiries.
  • Performs varied activities and moderately complex administrative/operational/customer support assignments.
  • Performs computations.
  • Typically works on semi-routine assignments.

Inbound Contact Representative 1/Dis-enrollment

Humana
Tampa, FL
2019.03 - 2018.08
  • Take incoming calls from members who call for dis-enrollment from their plans.
  • Advise members (Medicaid) eligibility status, dis-enrollment processing procedures and status to members as well as authorizations callers.
  • Preform updates to the system on account such as status of account, status of the member, and if members have passed away.

Dispatcher

USIC
Tampa, FL
2018.07 - 2018.03
  • Responsible for the correct, safe, and efficient locating of underground utilities including telecommunications, electric power, cable TV, gas, water, and sewer systems.
  • Thoroughly search for underground utilities in an area, properly marking the location, completing the necessary paperwork, and photographing each location.

Contractor

Judge group
Nashville, TN
2017.04 - 2016.11
  • On Life Health Member Service Specialist- Providing first call resolution, pleasant customer experience, and superior problem-solving IT service.
  • Corrected or reported issues that affected the point system of each policy owner.
  • Advise the policy holders on the rules and regulation of the health program that they are with BCBS.

Operator

Yates Services
Smyrna, TN
2018.02 - 2016.08
  • Assembly of automobiles and automotive parts.
  • Work as part of a team at a workstation along an assembly line completing a designated section of the product before moving it along to the next station.
  • Work with air and/or battery power tools and hand tools.
  • May work as a member of assembly, paint or other groups and be assigned different work stations/rotations as productions needs require.
  • Follow guidelines specific to each department.

Loader

UPS
Nashville, TN
2017.08 - 2016.08
  • Loading and unloading packages from trucks, assuring safety rules for myself and others, handling deliveries that come in to HUB.

Contractor

Dell Inc.
Nashville, TN
2016.09 - 2016.06
  • North American Administrators- provides assistance to members, providers, or other inquiring about eligibility, claims issues, and product information or experiencing customer service problems.
  • Assesses caller's needs, makes appropriate recommendations or action and aims for first call resolution.
  • Resolve complex or escalated issues of callers by thoroughly researching the cause of an error.
  • Understands and accurately interprets product benefits, applicable state and federal guidelines/regulations and department policies.

Contractor

K Force
Tampa, FL
2016.05 - 2015.12
  • Chase Auto Financial: Collect on accounts where funds were owed, reconciliation on loans to bring to a current status, research on account if customers have question on accounts, and report all actions while collecting on accounts to ensure that there are up to state/federal guidelines.

Contractor

Maxim Healthcare Services
Tampa, FL
2015.11 - 2015.10
  • CVS/Caremark Coram: Billing Specialist- Follow up on aged balances that are 30-day or more.
  • Work with third party payers for reimbursement on patient accounts, identifying and preparing adjustments and write offs as appropriate.
  • Followed-up on daily correspondence (denials, low pays) to appropriately work patient accounts, interfacing with insurance companies via telephone to check claim status, written correspondence to payers and patients.
  • Interpreted contracts with payers to safeguard proper payment, sending initial or secondary bills to insurance companies.
  • Process refunds/reinstatements/ rejections of insurance claims, running reports on a weekly and monthly basis.

Contractor

Kelly Services
Nashville, TN
2017.07 - 2015.05
  • Cigna Health Spring Network Operations - Review and research documents that were received from Specialist, Doctors, hospitals, and other health care facilities.
  • Confirm that credentials from said people or facilities were correct and up to date.
  • Corrected and reported any issues that could affect members due to misinformation issued by Cigna.

Contractor

SNI Companies
Tampa, FL
2015.08 - 2015.03
  • Freedom health: Concierge Specialist- Providing first call resolution, pleasant customer experience, and superior problem-solving customer service.
  • Explain benefits, eligibility status, enrollment processing procedures and status to members as well as authorizations callers.
  • Working with provider and various departments to resolve issues that the member may have.

Education

Associate Degree - Computer Animation

Art Institute of Ft Lauderdale
Ft Lauderdale, Florida
01.1998

Basic College Class -

Hillsborough Community College
Tampa, Florida
01.1996

Diploma -

Thomas Jefferson High School
Tampa, Florida
06.1994

Skills

  • Microsoft Word, Excel, Access, and Outlook
  • Call center operations
  • Data entry
  • Relationship management
  • Multi-channel support
  • Team collaboration
  • Strong interpersonal skills
  • Quality assurance
  • AS/400
  • Claims processing
  • Medicaid eligibility
  • Customer service

Timeline

Inbound Contact Representative 1/Dis-enrollment

Humana
2019.03 - 2018.08

Dispatcher

USIC
2018.07 - 2018.03

Operator

Yates Services
2018.02 - 2016.08

Loader

UPS
2017.08 - 2016.08

Contractor

Kelly Services
2017.07 - 2015.05

Contractor

Judge group
2017.04 - 2016.11

Contractor

Dell Inc.
2016.09 - 2016.06

Contractor

K Force
2016.05 - 2015.12

Contractor

Maxim Healthcare Services
2015.11 - 2015.10

Contractor

SNI Companies
2015.08 - 2015.03

Inbound Contact Representative 2/Long Term Care Florida Medicaid

Humana
2005.10 - 2019.03

Associate Degree - Computer Animation

Art Institute of Ft Lauderdale

Basic College Class -

Hillsborough Community College

Diploma -

Thomas Jefferson High School

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Ramon Lugo Jr