ROCIO G CARRILLO

Applied program rules, regulations, policies, and procedures for Unemployment eligibility determinations. Conducted interviews to gather information for
determination of eligibility. Advised customers of their responsibilities in
participation in the program. Reviewed and retrieved information for initial and
continued benefits from automated databases. Resolved issues and complaints
regarding program services. Referred customers to community and social services
agencies that may be of assistance to customers. Ability to communicate
with hostile customers. Completion of extra assignments in addition to assigned
workload and assist peers with general and adjudication questions.

• Assisted customers with banking needs by handling inquiries about accounts, loans, credit cards, and transactions via phone.
• Investigating issues and processing requests like card replacements or account updates.
• Processed requests for account changes and updates.
• Make necessary account changes, process payments, and assist with self-service options.
• Collaborated with fraud and loan departments to resolve customer issues and enhance support.
• Focusing on metrics like resolution time and customer satisfaction.
• Develop and maintain expertise in various Citi products, services, and policies.
• Utilized computer systems to efficiently complete tasks and address customer inquiries.

• Worked in a fast-paced, high-volume contact center environment to provide product-specific reimbursement support to patients, healthcare providers, patient advocates, and manufacturer representatives.
• I frequently interacted via telephone with commercial payers to conduct insurance verifications and benefit investigations.
• Worked daily with commercial payers to ensure appropriate coverage and reimbursement in a variety of therapeutic areas.
• Had a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information, and maximize plan benefits.
• Obtained payer-specific prior authorization procedures and documentation requirements, if applicable, and facilitates the prior authorization process for patients and healthcare providers.
• Utilized knowledge of Medicare and Medicaid programs to assist patients.
• The position required sales, project management, and account coordination skills, depending on the specific program.
• Key Responsibilities: Contacted the payer to verify patient eligibility and product-specific coverage information.
• Interfaced with physicians, advocates, patients, and manufacturer representatives to obtain and provide drug-specific coverage information.
• Provided prior authorization assistance, as well as claims assistance, including billing and coding instructions, to physicians and/or office staff.

• Provided support and assistance to patients, enhancing their healthcare experience and promoting well-being.
• Facilitated daily challenges to improve health outcomes and promote healthier lifestyles for patients.
• Investigated medication approval processes, collaborating with case managers to provide timely status updates to patients and healthcare providers.
• Followed established guidelines to conduct thorough investigations.
• Provided accurate and timely follow-up to all reimbursement inquiries in accordance with program guidelines.
• Ensured that the intake information was accurate and completed in order to perform all reimbursement research.
• Researched and compiled payer-specific information for the reimbursement database.
• Utilized internal resources to identify and provide alternate funding sources for patients without insurance, or adequate coverage through their insurance.

• Responded to customer inquiries via telephone and written correspondence, providing timely follow-up to ensure customer satisfaction.
• Delivered information to members regarding pharmacy and medical orders to patients and physicians.
• Input patient information into the Customer Relationship Management application (CRM) and manage patient billing services.
• Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application.
• Maintain performance and quality standards based on established call center metrics, including turn-around times.
• Identified trends in incoming and outgoing calls, recommending policy or process improvements to enhance customer service quality and reduce call volume.
• Researched and identified processing inaccuracies in claim payments, routing them to the appropriate site operations team for timely adjustments.

• Managed workload by conducting interviews and reviewing information, facilitating timely access to initial and continued benefits.
• Communicated with employers and employees to clarify federal agency statutes, ensuring compliance and understanding of the program.
• Resolved customer service inquiries efficiently, enhancing overall satisfaction and supporting program objectives.
• Advise customers of their responsibilities in participating within the program.
• Resolve routine issues and complaints from customers.
• Completed Adjudication training in April 2016 and managed a full caseload starting in August 2016.
• Maintained calm, friendly demeanor with upset customers to de-escalate stressful situations.
• Operated various office equipment, including computer systems and software, to perform daily tasks efficiently.