Sandy Figueroa
Arlington
Summary
Experienced with handling patient inquiries and providing support in healthcare setting. Utilizes strong communication skills and empathy to resolve issues and ensure patient satisfaction. Knowledge of healthcare protocols and procedures, contributing to efficient and effective service delivery.
Overview
14
14
years of professional experience
Work History
Data Entry /Healthcare Customer Service Representative
Imaginet
Dallas, TX (Remote)
12.2025 - Current
- Verified eligibility for Optum & Health Care Providers
- Updating large scale weekly Optum member spreadsheets for active Members for proper claims filings
- Facilitated training sessions for new staff on enrollment procedures and best practices, enhancing team performance.
- Proficient in IDX, Citrix, Five9, Availity & Health Plan sites for 100 plus Insurance companies as a part of Optum.
- Delivered exceptional customer support by resolving inquiries and providing accurate information on Optum California IPA's and services.
Medicare Customer Support Agent
Hays (Cognizant Inc)
Arlington, Texas (Remote)
09.2023 - 04.2025
- Extensive knowledge of Medicare Advantage Plans for Providers & Members.
- Knowledge of claims processing, and explanation of many Advantage plan explanation of coverage.
- Assisted in filing coverage determinations for Part D exceptions.
- Assisted the members in setting up member portal online & the mobile app.
Customer Service Agent
Mindlance / Centene Corp.
Dallas, Texas (Remote)
04.2023 - 06.2023
- Managed inbound 200 daily calls, enhancing service efficiency and customer satisfaction.
- Proficient in Salesforce and Microsoft Office
- Enhanced customer experience through effective problem-solving in benefit coverage explanation.
- Assisted with social services, ensuring high-quality support, and resources for the members, and non-members of the plan.
- Improved call resolution rates by implementing targeted training, leading to substantial improvements in customer satisfaction scores.
Grievance Coordinator
Spectraforce / Cigna Health Care
Raleigh, North Carolina (Remote)
09.2022 - 12.2022
- Investigated & Resolved member complainants.
- After investigation for members ensuring positive member experiences, and proper resolution of the member experience.
- Coordinated with grievance team for accurate written delivery to the member of the handling process.
- Analyzed root cause of grievance to improve operations and member satisfaction.
Member Services Representative
Insight Global / Evolent Health Care
Dallas, Texas (Remote)
11.2021 - 04.2022
- Handled inbound 200+ daily members with ACA policy details, assuring satisfaction, detailed premium issues.
- Explained to the members OOPM, to the deductibles, as well as EOB details.
- Assisted members with premium issues, inquiries of late enrollment penalties, and prior authorization / referral status.
- Resolved escalated calls for a complete positive outcome.
Provider Services Associate
Insight Global / Molina Health Care
Dallas, Texas (Remote)
10.2020 - 10.2021
- Verified members eligibility & benefits for In-network/ Out of Network providers
- Assisted in resolving provider inquiries, enhancing communication between healthcare providers for claims internal teams.
- Clarified Out of Pocket Maximum (OOPM) and deductible accumulations with all benefit details for member cost share responsibility.
- Checked CPT codes, prior authorizations, and referrals for the providers & policyholders
- Assisted Providers in accessing forms, resubmission, claims payments & all aspects of the claim processing.
Member & Provider Services Associate
Insight Global / Molina Health Care
Dallas, Texas (Remote)
10.2019 - 07.2020
- Managed member and provider benefit inquiries, delivering timely accurate responses to enhance professional service quality. Inbound calling in a fast paced call center environment.
- Explained the prescription cost share, prior authorizations, and coverage determinations for providers & members.
- Deescalated dissatisfaction, expressing empathy while maintaining professionalism to the members and providers.
- Explained all aspects of billing and processing member payments.
Customer Service Representative
Pacific Dental Services
Irving, Texas, United States
12.2018 - 05.2019
- Managed & maintained dental appointments for nationwide In-network providers, updating members dental charts (Salesforce) for the selected dental office.
- Addressed complaints empathetically, achieving positive resolutions.
- Streamlined patient scheduling processes, reducing wait times and enhancing appointment efficiency for better patient flow. Also, available to assist the members for emergency situations in contacting the dentist immediately for weekend appointments.
Claims Processor
Lynx Services / State Farm
Irving, Texas, United States
07.2018 - 11.2018
- Resolved customer issues and processed claims efficiently, ensuring policy compliance.
- Reviewed and verified insurance data / deductable, maintaining accuracy and reducing errors.
- Organized claims forms, ensuring completeness and adherence to guidelines.
- Followed standards to prevent processing errors, enhancing service quality for totaled vehicle pickup.
- Also processed glass claims (State Farm) efficiently, ensuring compliance with policy guidelines, deductible which expedited claim resolutions.
Outbound Customer Service Agent / Production Assistant
Dealertrack / Cox Automotive
Dallas, Texas, United States
10.2012 - 05.2018
- Managed daily customer interactions for new purchases, preowned, and service department interactions for the contracted 200 dealerships.
- Documented calls meticulously, enhancing service quality for contracted dealerships feedback, ensuring satisfaction, and resolving issues efficiently.
- Coordinated logistics as a production assistant. Prepared accurate reports, supporting dealership operations in the new/ preowned or service department for the staff at the dealerships.
- Facilitated communication with dealerships, maintaining up-to-date staff information.
- Converted dissatisfied clients into repeat customers, boosting company performance.
- Streamlined communication processes with dealerships, enhancing information accuracy and fostering stronger partnerships with our customer base.
Education
High School Diploma -
Venture High School
Arlington, TX06-2006
Skills
- Microsoft Office
- QNXT / CRM / Salesforce
- Multitasking
- Teamwork
- Customer Service
- Claims Processing
- Healthcare
- Insurance Knowledge
- Fast-paced environment
- In & Outbound call center experienced
Timeline
Data Entry /Healthcare Customer Service Representative
Imaginet
12.2025 - Current
Medicare Customer Support Agent
Hays (Cognizant Inc)
09.2023 - 04.2025
Customer Service Agent
Mindlance / Centene Corp.
04.2023 - 06.2023
Grievance Coordinator
Spectraforce / Cigna Health Care
09.2022 - 12.2022
Member Services Representative
Insight Global / Evolent Health Care
11.2021 - 04.2022
Provider Services Associate
Insight Global / Molina Health Care
10.2020 - 10.2021
Member & Provider Services Associate
Insight Global / Molina Health Care
10.2019 - 07.2020
Customer Service Representative
Pacific Dental Services
12.2018 - 05.2019
Claims Processor
Lynx Services / State Farm
07.2018 - 11.2018
Outbound Customer Service Agent / Production Assistant
Dealertrack / Cox Automotive
10.2012 - 05.2018
High School Diploma -
Venture High School