Crm, tea
Tamara Camille Hernandez
Corpus Christi,TX
Summary
Tamara is highly experienced in call center environments, adept at managing high-volume inbound calls and delivering comprehensive customer support for Medicare and healthcare-related inquiries. She possesses a strong background in Medicare, insurance, and Managed Care Organization (MCO) processes, including expertise in plan changes, authorizations, eligibility verification, and benefits education. Tamara is skilled in guiding and educating members on services such as Primary Care Provider (PCP) changes, issuing ID cards, transportation coordination, and enrollment procedures. She demonstrates a proven ability to efficiently resolve claims, coverage, and billing issues, ensuring high levels of customer satisfaction and timely problem resolution. Her hands-on experience in care coordination and patient support includes facilitating referrals, providing medication assistance, and helping individuals navigate complex healthcare systems. Tamara is proficient in using CRM systems, maintaining accurate documentation, and upholding HIPAA compliance when handling sensitive patient and member information. She has a history of meeting performance metrics, contributing to improved call center operations, and consistently delivering empathetic, high-quality customer service.
Overview
26
26
years of professional experience
Work History
Member Service Advocate
SCAN Health Plan (Contract: Johnson Service Group)
10.2025 - 04.2026
- Responsible for handling Medicare plan changes, including updates, PCT request changes, and overall member plan modifications.
- Managed specialist changes, authorizations, prior authorizations, and medication updates as part of member plan support.
- Assisted with requests for DME (durable medical equipment) and ensured proper processing of related needs.
- Followed all HIPAA laws and regulations while handling sensitive member and insurance-related information.
- Addressed all insurance-related inquiries and questions from members regarding their plans and services.
- Primarily handled inbound calls (approx. 85 calls), with outbound calls conducted for follow-ups and updates on previous requests.
- Provided education and assistance to members regarding benefits and services, including PCP changes and plan-related support.
- Assisted with ID card requests, especially for members who did not receive them during AEP/OEP periods.
- Coordinated transportation services and other member support services as needed.
- Ensured timely follow-up and resolution of member concerns, maintaining a high level of service and support.
Patient Care Advocate
Cigna/Accredo/Express Scripts
09.2024 - 10.2025
- Facilitated medication refills, prior authorizations, and copay assistance, ensuring timely access to therapy for eligible patients.
- Gained experience with medication processes while working in Specialty Pharmacy for Cigna, focusing on insurance aspects related to senior care and young adults.
- Primarily handled insurance-related support for medications and coverage; no direct experience working with children or infants in a healthcare or service capacity.
- Studied early childhood education in college but did not pursue it professionally, with experience remaining focused on insurance aspects rather than childrelated services.
- Assisted patients in navigating healthcare systems, understanding resources, and completing documentation for insurance claims and medical records.
- Maintained accurate records of patient interactions, follow-ups, and transactions to streamline processes and ensure compliance.
- Built strong relationships with pharmacies and coordinated referrals to specialists, ensuring continuity of care and preventing therapy gaps.
- Resolved communication, billing, and service issues promptly, often during initial contact, enhancing patient satisfaction.
- Demonstrated empathy and provided emotional support to diverse patient populations, fostering trust and positive experiences.
- Verified insurance eligibility, scheduled appointments, answered calls, and directed inquiries to appropriate personnel.
- Maintained strict confidentiality of patient information while adhering to documentation protocols and healthcare standards.
- Monitored ongoing care, proactively identified issues, and implemented corrective actions to improve service quality.
Medicare Customer Service Representative
Results CX
01.2023 - 09.2024
- Assisted clients with Medicare inquiries, providing clear, accurate information on coverage, benefits, and enrollment processes.
- Resolved claims and coverage issues efficiently, ensuring high customer satisfaction and timely issue resolution.
- Managed high-volume inbound calls while maintaining professionalism, empathy, and focus on customer needs.
- Utilized CRM systems to track interactions and manage client accounts effectively for improved service delivery.
- Maintained up-to-date knowledge of Medicare regulations and policies to ensure compliance and accurate communication.
- Supported enrollment processes for new beneficiaries, guiding them through each step for seamless transitions into coverage plans.
- Coordinated with internal departments and healthcare providers to facilitate issue resolution and streamline claim processing.
- Consistently met or exceeded performance metrics related to call quality, timeliness, and accuracy, improving call center performance.
- Built strong, empathetic client relationships, delivering exceptional customer service and exceeding service standards.
- Trained new hires on company protocols, systems, and communication techniques while adapting effectively to changing environments.
Apple - Sales Advisor Mac Expert
Concentrix
01.2021 - 01.2023
- Engaged customers to identify needs, recommend suitable products, and provide expert product knowledge for informed purchasing decisions.
- Executed daily sales strategies and consistently exceeded sales targets through effective demonstrations and persuasive communication.
- Increased sales by building rapport, offering purchase advice, and promoting additional products to maximize revenue.
- Managed inventory levels and assisted in visual merchandising to ensure product availability and enhance the shopping experience.
- Resolved customer inquiries and complaints professionally, maintaining satisfaction and preserving long-term relationships.
- Analyzed sales trends and stayed current on product offerings and industry changes to optimize promotions and displays.
- Provided after-sales support, monitored service outcomes, and implemented quick, effective problem resolutions.
- Coordinated with cross-functional teams such as marketing and logistics to ensure seamless operations during peak periods.
- Managed key accounts and built strong customer relationships, driving repeat business and customer loyalty.
- Mentored junior staff, maintained a professional brand image, and contributed to a positive, high-performance work environment.
Assistant Property Manager
Orion Realty
01.2000 - 01.2015
- Coordinated tenant communications, addressed inquiries, and resolved complaints promptly to enhance satisfaction and retention rates.
- Gained hands-on experience supporting disabled individuals through property management (tax credit housing), working in alignment with Corpus Christi Housing Authority and fair housing guidelines, though not directly through the insurance side.
- Assisted in accommodating disabled residents by coordinating available housing units based on their needs, including working with Disability Advocates (e.g., for blind residents) and ensuring rental support processes were properly handled.
- Ensured all documentation, forms, and income qualifications were accurately completed and compliant, while coordinating with specialists who primarily managed the residents’ advocacy and care needs.
- Managed tenant move-in/move-out procedures, conducted inspections, and completed final walk-throughs ensuring compliance with lease agreements.
- Assisted in property maintenance scheduling, vendor management, and coordinated timely repairs to uphold community standards.
- Streamlined lease administration and rent collection processes, improving document accuracy, cash flow, and reducing delinquencies.
- Processed tenant applications, conducted background checks, and verified income, assets, and references to select qualified tenants.
- Developed and implemented marketing strategies, including open houses and social media outreach, to reduce vacancy rates and increase occupancy.
- Maintained accurate records of tenant correspondence, transactions, and prepared detailed property performance and financial reports.
- Supported budget preparation and expense tracking, identifying cost-saving opportunities and monitoring financial goals.
- Built strong relationships with tenants and vendors, negotiated contracts, and coordinated services for cost-effective property operations.
- Trained new staff on policies, procedures, and best practices while collaborating with teams and legal departments on escalations and eviction processes.
Education
High School Diploma - undefined
Richard King High School
Corpus Christi, TXSkills
Call center operations
Customer service and support
Medicare, Medicaid, and MCO expertise
Insurance verification and eligibility
Prior authorization and claims management
Care coordination
HIPAA compliance
CRM software proficiency
Data entry and documentation
Inbound call handling
Problem resolution
Patient advocacy
Transportation coordination
PCP changes and ID card requests
Enrollment support
Communication and empathy skills
Microsoft Office Suite proficiency
Team collaboration
Customer service
Customer support
Strong interpersonal skills
Call center experience
Relationship building
Account reconciliation
Document processing
Payment processing
Issue resolution
Workflow optimization
Dispute resolution
Client education
Account management
Service recommendations
Database management
Membership renewals
Tracking complaints
Healthcare
Member account management
Data security techniques
Member correspondence
Teamwork
Teamwork and collaboration
Problem-solving
Problem-solving skills
Time management
Attention to detail
Problem-solving abilities
Multitasking
Calm and professional under pressure
Reliability
Excellent communication
Computer skills
Understanding customer needs
Customer service excellence
Organizational skills
Calm under pressure
Active listening
Effective communication
Adaptability and flexibility
Verbal and written communication
Decision-making
Teamwork skills
Customer relations
Microsoft office
Phone etiquette
Team building
Data entry
Task prioritization
Stress tolerance
Self motivation
Product knowledge
Medical terminology
Interpersonal skills
Customer relationship management
Analytical thinking
Conflict resolution
Work prioritization
Information gathering
Professionalism
Goal setting
Issue and complaint resolution
Interpersonal communication
Quality control
Administrative and office support
Resourcefulness
MS office
Complaint resolution
Record keeping
De-escalation techniques
Time management abilities
Continuous improvement
Product and service sales
Adaptability
Written communication
Quality assurance
Professional telephone demeanor
Billing procedures
Accomplishments
Met all QUALITY METRICS EFFICIENTLY
Affiliations
Specialty Pharmacy Experience
Software
Salesforce
CSP
Microsoft
Teams
Record keeping
Interests
Specialty Pharmacy
Customer Support
Patient Care Advocate
Timeline
Member Service Advocate
SCAN Health Plan (Contract: Johnson Service Group)
10.2025 - 04.2026
Patient Care Advocate
Cigna/Accredo/Express Scripts
09.2024 - 10.2025
Medicare Customer Service Representative
Results CX
01.2023 - 09.2024
Apple - Sales Advisor Mac Expert
Concentrix
01.2021 - 01.2023
Assistant Property Manager
Orion Realty
01.2000 - 01.2015
High School Diploma - undefined
Richard King High School