Sierra Larez
Stockton,CA
Summary
Dedicated and detail-oriented professional with over five years of experience in customer service, healthcare operations, patient support, and client relations. Expertise includes resolving complex member and provider inquiries, managing documentation, and supporting appeals and grievance processes with precision and professionalism. Proficient in Microsoft Office and data management while maintaining confidentiality in compliance with healthcare regulations. Recognized for exceptional attention to detail, strong organizational and analytical skills, and a proven ability to manage high-volume workloads while delivering compassionate, solution-focused service that ensures positive customer experiences.
Overview
5
5
years of professional experience
Work History
Appeals and Grievance Coordinator
Blue Shield of California
Lodi, CA
05.2024 - 04.2026
- Processed and reviewed member and provider appeals in compliance with regulatory requirements and established timelines.
- Analyzed clinical and non-clinical documentation to support accurate case determinations.
- Coordinated with providers, case managers, and internal teams to gather information and resolve complex issues.
- Maintained accurate, confidential records and documentation in compliance with HIPAA standards.
- Communicated appeal and grievance decisions to members and providers in a timely and professional manner.
- Managed a high-volume caseload while meeting productivity, quality, and turnaround-time goals.
- Identified trends and supported process improvements to enhance operational efficiency and member satisfaction.
Senior Markets Customer Service Representative
Blue Shield of California
Lodi, CA
09.2021 - 04.2024
- Assisted members, providers, and brokers with benefit, eligibility, enrollment, and coverage inquiries.
- Built and maintained relationships with community partners, providers, and stakeholders to support membership growth.
- Educated members on health plan benefits, programs, and available resources.
- Resolved complex customer concerns and escalated issues as needed to ensure timely resolution.
- Conducted outreach and enrollment activities while ensuring compliance with regulatory requirements.
- Maintained accurate records and documentation in customer relationship management systems.
- Collaborated with cross-functional teams to improve member satisfaction and retention.
- Consistently met performance, productivity, and customer service goals.
Education
High School Diploma -
Venture Academy
Stockton, CA06-2013
Skills
- Conflict Resolution & De-escalation
- Appeals & Grievance Processing
- Microsoft Office (Excel, Word, Outlook)
- Time Management & Multitasking
- Customer Service & Client Relations
- Attention to Detail
- Written & Verbal Communication
- Assertiveness
- Teamwork and collaboration
- Organizing and prioritizing work
- Reliability and Active Listening
- Computer proficiency and Document skills
Timeline
Appeals and Grievance Coordinator
Blue Shield of California
05.2024 - 04.2026
Senior Markets Customer Service Representative
Blue Shield of California
09.2021 - 04.2024
High School Diploma -
Venture Academy