ROSA MARTINEZ
Passaic,NJ
Summary
Diligent Bilingual Customer Service Specialist that brings top skills in customer service, data entry and conflict resolution. Recognized for resolving customer complaints with integrity and professionalism to maintain customer satisfaction and retention. Motivated team player committed to contributing to company success goals. Detailed Data Entry Clerk with experience inputting and organizing data in various software and applications. Extensively trained in transcription, word processing and spreadsheets. Organized individual recognized for transposing large amounts of data with accuracy and speed. Self-motivated Insurance Verification Specialist proudly offering over 2 years' experience building an understanding of medical terminology while tracking patient coverage. A poised professional with benefits explanation and administration expertise. Offering time management and interpersonal skills.
Overview
10
10
years of professional experience
Work History
Customer Service Representative Agent
Lumeris
12.2022 - 02.2024
- Maintained accurate and detailed records of customer interactions and service requests in the company's CRM system
- Handled an average of 60 customer interactions per day, maintaining a high level of professionalism and attentiveness to client needs
- Achieved a customer satisfaction rating of 95% through excellent communication and problem-solving skills
- Remained calm and professional in stressful circumstances and effectively defused tense situations
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Speaking to members about their co payment cost, plan information, claim information, general benefits information.
- Calling for referral if needed, why there is a cost to the copay, if services are covered, looking for participating providers.
- Speak to Customers in Spanish & Document the Call in English
Bilingual Customer ServiceRepresentative
Maximus Health
01.2020 - 09.2022
- Handled a high volume of customer calls and email in both English and
- Spanish, maintaining an average of 45 interactions per day
- Adheres to and participates in company's mandatory HIPPA privacy program/ practices and business Ethics and compliance programs/ practices enrolled and disenrolled members in health insurance health plans as well as dental plans , reinstating pushing back health insurance start dates with qualifying life events
- Processing applications reading privacy acts over telephone with consumers
- Actively participated in ongoing training and professional development programs to enhance product knowledge and customer service skills
- Collaborated with team members and supervisors to improve customer service processes
- Identified and corrected problems before government and insurance payers could challenge incorrect coding
- Presented audit findings and identified opportunities within the organization for training
- Reviewed medical claims to detect unlawful or incorrect Medicare payments
Data Entry Clerk
Elevance Health | NJ
07.2017 - 09.2019
- Entered and verified a high volume of data accurately and efficiently into the company's database, ensuring minimal errors and maintaining a 99.9% accuracy rate
- Collaborated with the IT department to troubleshoot data entry software issues, resulting in a 25% decrease in system downtime and improved data entry efficiency
- Implemented data quality control measures, including regular data audits and validation checks
- Handled incoming and outgoing correspondence, including emails and phone calls, effectively prioritizing and responding to inquiries
- Performed data entry from paper documents, emails, and other sources into computer systems.
Insurance Verification Specialist
Humana
, NJ
02.2014 - 11.2016
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Processed manual claims when necessary due to incorrect or incomplete information from providers or patients.
- Collaborated with internal staff members such as Billing Specialists, Medical Coders., to resolve any discrepancies in patient's insurance information.
- Updated patient and insurance data and input changes into company computer system.
- Entered data in EMR database to record payer, authorization requirements and coverage limitations.
Education
High School Diploma -
Life Science Secondary School
01.2013
Skills
- Microsoft Office Suite
- Google Suite
- Microsoft Teams
- Microsoft Outlook
- Active Listening
- Typing 55 WPM
- Excel Spreadsheet
- Problem Resolution
- Project Management
- Knowledge of CPT and ICD-9 coding
- Technical Knowledge
- Claims Processing
- Navigating multiple screens
- CRM Software
Timeline
Customer Service Representative Agent
Lumeris
12.2022 - 02.2024
Bilingual Customer ServiceRepresentative
Maximus Health
01.2020 - 09.2022
Data Entry Clerk
Elevance Health | NJ
07.2017 - 09.2019
Insurance Verification Specialist
Humana
02.2014 - 11.2016
High School Diploma -
Life Science Secondary School
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