Sherrelle Saldana
Webster,TX
Summary
Medical Customer Service Representative;
Enthusiastic about helping patients get necessary medical support by obtaining authorizations, scheduling procedures and coordinating paperwork. Detail-oriented and proactive with good relationship-building skills, a hardworking nature and an adaptable approach.
Overview
12
12
years of professional experience
Work History
Medical Claims Representative
TriCare - Humana Miltary
Remote
12.2023 - Current
- Improved patient satisfaction by efficiently processing medical claims and addressing inquiries.
- Reduced claim processing time by implementing streamlined workflows and maintaining thorough documentation.
- Enhanced accuracy of processed claims with meticulous attention to detail and knowledge of coding systems.
- Collaborated with healthcare providers for timely resolution of discrepancies, ensuring accurate reimbursement.
- Managed high-volume claim submissions, consistently meeting deadlines and maintaining a high level of accuracy.
- Provided excellent customer service to both patients and healthcare providers during the entire claims process.
Medical Member Service Representative
Superior Health Plan Inc
Remote , TX
01.2021 - 12.2023
- Handle incoming and outgoing correspondence, maintain files and records, perform data entry, maintain office calendars and schedules, keep office clean, safe and organized and keep office supply inventory fully stocked.
- Assisted members with correcting account, service, and system issues by educating on required forms and technical processes.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Managed large volume of medical claims on daily basis.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
Customer Service Representative
CIGNA HealthCare Of AZ
Remote , TX
06.2018 - 01.2021
- Receives requests via telephone regarding Insurance application status and Commissions
- Responds to inquiries from Independent and Cigna Agents and/or agencies for information and assistance
- Performs research to respond to inquiries and interprets notifications to determine most effective response
- Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity.
- Managed over 100 customer calls daily
- Offered advice and assistance to customers, paying attention to special needs or wants
Customer Service & Sales Rep
Empereon Call Center
Alvin, TX
11.2016 - 06.2018
- Developed customer service policies and procedures to meet and exceed industry service standards
- Identify customer questions, complaints, concerns, and overall needs
- Provide sufficient answers and solutions to all customer queries
- Handle customer complaints respectfully and professionally
- Tracked customer service cases and updated service software with customer information
HR Administrative Assistant
American National Insurance
Houston, Webster, TX
08.2014 - 11.2016
- Executed record filing system to improve document organization and management.
- Scheduled office meetings and client appointments for staff teams.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Sorted and distributed office mail and recorded incoming shipments for corporate records.
Front Desk Receptionist (Testing Center)
College Of The Mainland
Texas City, TX
08.2012 - 08.2014
- Answer telephones and give information to callers, take messages, or transfer calls to appropriate individuals
- Use computers for various applications, such as database management or word processing
- Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions.
Education
High School Diploma -
Clear Brook High School
Friendswood, TXAssociate of Science -
Houston Community College
Houston, TXSkills
- Microsoft word
- Processing claims
- P>Team leadership
- Sales Planning and Scheduling
- Organizational & Multi-tasking Skills
- P>Report preparation
- P>Professional telephone demeanor
- P>Account management
- P>Administrative support
- P>Recordkeeping strengths
- P>Telephone etiquette
- P>Medical Claims
- P>HIPPA
- Healthcare regulations
- Medical software
- Insurance Claims
- Medical Terminology
- Medical terms and procedure knowledge
- 15 years Customer Service
- Eligibility Determination
- Relationship Building
Timeline
Medical Claims Representative
TriCare - Humana Miltary
12.2023 - Current
Medical Member Service Representative
Superior Health Plan Inc
01.2021 - 12.2023
Customer Service Representative
CIGNA HealthCare Of AZ
06.2018 - 01.2021
Customer Service & Sales Rep
Empereon Call Center
11.2016 - 06.2018
HR Administrative Assistant
American National Insurance
08.2014 - 11.2016
Front Desk Receptionist (Testing Center)
College Of The Mainland
08.2012 - 08.2014
High School Diploma -
Clear Brook High School
Associate of Science -
Houston Community College