Raquel Rivera Reyes
Porter,TX
Summary
Highly motivated and skilled professional with expertise, knowledge, and background in a dynamic company. Committed to making a significant impact through strong skill set and experience in [relevant field]. Proven track record of achieving results via effective problem-solving, collaboration, and a strong work ethic. Eager to contribute to a team-oriented environment that values innovation and continuous growth.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Member Service Guide
Devoted
10.2023 - Current
- Provide assistance to Medicare Members in understanding their medical, dental, vision, food and home benefits.
- Provided deductible and copayment information
- Trained newly hired staff members
- Provided employee support
- Processed medical claims, reviewed benefits, educated members on policy, handled premium payments, and advocated for all customers.
- Successfully addressed and resolved complex customer issues
- Successfully managed the scheduling of doctor's appointments for Members
- Coordinate and arrange transportation appointments for Members
Property Independent Adjuster - Remote
Eberl
10.2020 - Current
- Conduct remote inspections on properties to assess damages caused by Catastrophe storms and other incidents
- Documented findings using photographs, scope sheets, and ECS system
- Utilized Xactimate to determine the monetary value of damages
- Ensured efficient and effective communication with insured clients concerning claim progress
- Streamlined inbound and internal customer service processes
- Delivered seamless access to Policy information and Policy Limits for various parties
- Provided support to policy holders for claims regarding additional living expenses, contents coverage for various properties including condominium units, rental dwellings and residential homes as well as personal articles in cases of damages caused by water intrusions or fire incidents.
- Virtual Inspections
- Investigate and Settle claims.
SR Customer Service Expert
Aetna/CVS
08.2014 - 03.2021
- Managed Medicare accounts and consistently delivered exceptional service with first call resolution.
- Managed escalated member calls
- Achieved high customer satisfaction ratings through prompt and effective assistance.
- Managed customer grievances effectively through comprehensive documentation and resolution
- Processed medical claims, reviewed benefits, educated members on policy, handled premium payments, and advocated for all customers.
- Quality Assurance/Call Monitoring
- Peer Evaluations
- Peer Mentoring
- Peer Training
- Special Projects.
Administrative Assistant/Customer Service
Royal Appliance
07.2013 - 08.2014
- Inbound Customer Service
- Schedule Staff domestic travel for Meetings/Training
- Maintain Inventory
- Assist Walk in Customers
- Shipping and Receiving
- Accounts Receivable
- Accounts Payable
- Set Route Schedule for Technicians
- Open and Close Registers
- Daily Bank Deposits.
Education
No Degree - Art
Laredo Community College
Laredo, TXHigh School Diploma -
Zapata High School
TX Property Adjuster License Certification -
The Adjuster School
09.2020
Skills
- Bilingual English/Spanish
- Microsoft Office
- Xactimate
- ECS
- Excel
- Microsoft Word, etc
Certification
- TX Adjuster All Lines for AL, FL, KY, LA and MS
- Adjuster Property & Casualty (including Worker's & Casualty, TX and CO - General Lines - Life, Accident and Health
References
- Billy Weedon, Manager, Austin, TX, 512-694-6935
- Karina Valencia, Supervisor, Spring, TX, 832-874-9291
- Freddie Donaldson, Trainer, Atlanta, GA 678-378-8410
Languages
Spanish
Native or Bilingual
Timeline
Member Service Guide
Devoted
10.2023 - Current
Property Independent Adjuster - Remote
Eberl
10.2020 - Current
SR Customer Service Expert
Aetna/CVS
08.2014 - 03.2021
Administrative Assistant/Customer Service
Royal Appliance
07.2013 - 08.2014
No Degree - Art
Laredo Community College
High School Diploma -
Zapata High School
TX Property Adjuster License Certification -
The Adjuster School
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