Raquel Esmeralda Robles
Phoenix
Summary
Strong background in customer interactions and service solutions. Highly skilled in conflict resolution, communication, and problem-solving, ensuring customer satisfaction and loyalty. Effective team collaborator, adaptable to changing needs, and consistently focused on achieving results through efficient and empathetic service. Known for reliability and proactive approach to meeting customer and organizational goals.
Overview
6
6
years of professional experience
Work History
Customer Service Representative
MedImpact
09.2024 - Current
- Utilize multiple company database programs to research and resolve complex issues relating to benefit information, claims adjudication, eligibility verification, prior authorization, and other PBM processes.
- Educate external customers about MedImpact’s roles and responsibilities. Provide information about override guidelines, benefit plan restrictions, prior authorization requirements, grievance and appeal processes, and other PBM functions as specified by health plan sponsors in online CS Notes.
- Follow up with callers as appropriate to ensure customer satisfaction and timely response to requests. Diffuse irate or emotionally upset customers by appropriately listening to issues, calming the customer, and providing positive solutions to resolve concerns.
Airport Rental Car Team Lead
Managed Labor Solutions
01.2019 - Current
- Supervised and coordinated a team of rental car drivers, ensuring adherence to company policies and procedures for efficient fleet management
- Managed daily operations of the rental car department, including scheduling, route planning, and staff assignments to optimize service delivery
- Monitored driver performance and provided ongoing training and support to enhance service quality and operational efficiency
- Implemented and enforced safety protocols and regulatory compliance measures, reducing incident rates and ensuring a safe working environment
- Conducted regular inspections and maintenance checks on rental vehicles to ensure fleet safety, reliability, and cleanliness
Information Technology Intern
Amazon
01.2024 - 07.2024
- Assisted network engineers in removing cabling, un-racking switches, and wiped configurations during an access removal project
- Ensured compliance of 26 loaner laptops by charging them and running necessary ACME and Windows updates bi-weekly
- Conducted VLAN changes on various switches at GYR3, configuring interfaces and ensuring proper connectivity and monitoring system functionality
- Utilized ServiceNow to view and close tickets that involved password resets, account unlocks, security key setups, isolating computers, troubleshooting printers, provisioning computers, scanners, and thin clients, and setting up workstations
- Utilized tools like TightView for remote computer management, performing updates, screen setups, and user account unlocks as needed
Customer Service Representative
Centene
10.2021 - 04.2023
- Provided clear and accurate information regarding insurance policies, coverage options, and claim procedures to enhance customer understanding and satisfaction
- Processed policy applications, renewals, and endorsements, ensuring accuracy and compliance with company guidelines and regulatory requirements
- Managed and resolved customer complaints and concerns with empathy and efficiency, striving to achieve positive outcomes and maintain high customer satisfaction levels
- Collaborated with underwriters and claims adjusters to facilitate the processing of claims and ensure timely resolution of customer issues
Prior Authorization Specialist
CVS Caremark
05.2019 - 04.2020
- Verified medical insurance coverage to ensure patient eligibility and benefits
- Processed prior authorization requests to facilitate necessary medical treatments and services
- Evaluated individual requests for coverage authorizations, assessing medical necessity and policy compliance
- Collected essential documents and liaised with physician's offices to obtain additional information for coverage verification
- Completed payment approval processes for insurance, Medicare, and Medicaid prior to scheduling medical orders
Education
Information Technology Student -
Year Up
Phoenix, ArizonaStudent - Information Technology
Gateway Community College
Phoenix, Arizona07.2024
Skills
- Microsoft Office
- Outlook
- Excel
- Windows 10
- Windows 11
- Teamwork
- Organization
- Communication
- Customer Service
- Problem-solving abilities
- Active Listening
- Critical Thinking
- Customer Relations
- Conflict Resolution
Timeline
Customer Service Representative
MedImpact
09.2024 - Current
Information Technology Intern
Amazon
01.2024 - 07.2024
Customer Service Representative
Centene
10.2021 - 04.2023
Prior Authorization Specialist
CVS Caremark
05.2019 - 04.2020
Airport Rental Car Team Lead
Managed Labor Solutions
01.2019 - Current
Information Technology Student -
Year Up
Student - Information Technology
Gateway Community College
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