Silsa Salamanca
Fort Worth,Texas
Summary
Experience with medical claims, authorizations, and benefit verifications. Experienced in verifying complex data, inputting figures into client databases at an efficient pace, and maintaining the confidentiality of sensitive material. Reliable, hardworking, computer savvy, fast learner with exceptional organizational skills. Professionally and accurately handles incoming customer service calls. Extensive experience in marketplace insurance for the state. Proficient in handling various aspects of customer service including applications, eligibility reviews, and billing inquiries. Skilled in providing exceptional support to clients while ensuring compliance with insurance regulations and guidelines. Adept at enrolling members in health and dental plans, ensuring smooth and efficient processes from application to enrollment. Possess strong communication and problem-solving abilities, with a commitment to delivering superior service and fostering positive customer relationships in a remote work environment.
Overview
3
3
years of professional experience
Work History
Remote Customer Service Representative
Accenture
11.2023 - Current
- Handled customer inquiries and suggestions about their health and dental plans courteously and professionally.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Updated account information to maintain customer records.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Researched and resolved billing discrepancies to enable accurate billing.
- Resolved patient billing issues in line with established guidelines.
- Processed applications accurately, ensuring timely access to healthcare services for eligible members.
- Conducted thorough reviews of eligibility documentation, maintaining compliance with state and federal guidelines.
- Used data entry skills to accurately document and input statements.
- Updated, entered, and reviewed customer data.
- Assisted members in understanding complex health and dental application policies, guiding them through enrollment process step by step.
- Provided exceptional customer service during application submission, addressing any concerns or issues promptly and professionally.
- Handled high volume inbound calls, approximately 40/day
Remote Medicare Member Service Representative
Everise - Wellcare
09.2022 - 07.2023
- Gather and verify all required information in compliance with HIPPA
- Address and resolve member benefit inquiries and complaints empathetically and professionally all while building rapport
- Accurately document, research and resolve member’s concerns
- Manage incoming calls effectively and efficiently in compliance with company QA standards
- Refer grievances to designated departments for further assistance
- Educated members on their individual plan benefits
- Handle and research claims and authorizations for members as needed.
- Handled high volume inbound calls, approximately 40/day
Remote Customer Service Representative
U-Haul
04.2021 - 06.2022
- Provided customer information and recommendations on products and/or services such as truck rentals, storage facility management, and quotes
- Kept records of customer interactions and transactions by recording complaints, inquiries and actions taken
- Collected deposits and/or payment information as well as resolved billing complaints by refunding money and educating on charges
- Used multiple computers for various applications such as database management or word processing to create, maintain, or enter information.
- Handled high volume inbound calls, approximately 80/day
Education
High School Diploma -
Brewer High School
Fort Worth, Texas01.2016
Skills
- Proficient with Microsoft Office Suite
- Billing and Claims and Financial Transactions
- Computer Savvy with Extensive Research skills and Troubleshooting
- Remote Experience
- Health Care
- Successfully completed OSHA, ADA and HIPPA compliance trainings
- Customer Support
- Calm and Professional Under Pressure
- Data Entry
- Account updating
- Call Center Operations
- De-Escalation Techniques
- Following scripts
- Spanish and English Fluency
- Document and Records Management
- Policies and Procedures Adherence
- Call Documentation
- Salesforce CRM
- POS systems expert
- Multi-Line Phone Systems
Personal Information
Title: Customer Service and Data Entry Specialist
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Remote Customer Service Representative
Accenture
11.2023 - Current
Remote Medicare Member Service Representative
Everise - Wellcare
09.2022 - 07.2023
Remote Customer Service Representative
U-Haul
04.2021 - 06.2022
High School Diploma -
Brewer High School