Trixi Flores
Reseda,CA
Summary
Bilingual customer service professional with expertise in healthcare compliance, eligibility verification, and conflict resolution. Known for exceptional communication skills and collaboration with team members to enhance member satisfaction, with over more than 10 + years experience in Customer Service.
Overview
7
7
years of professional experience
Work History
Customer Service Agent
Centene Management Company
Woodland Hills, CA
12.2017 - 04.2025
- Responded promptly to inquiries from Members and Providers, coordinating with cross-departmental team members via phone, email, fax, or chat to ensure effective communication.
- Investigated and resolved Member complaints, filing Grievances and Appeals to facilitate timely resolutions.
- Maintained accurate records of interactions with Members and Providers to support effective follow-up and service continuity.
- Assisted Members with physicians, clinics and even Medical Groups changes upon request.
- Explained complex healthcare concepts to Members in an easy-to-understand way.
- Verified eligibility criteria for Members and Medical Providers.
- Ordered ID cards, Provider's directories, welcome packets, updated addresses, phone number for new and existing Members, etc.
- Worked with Providers over the phone, supporting information on Medical claim status, payment delays, requested check tracers, submitted claims back for review for additional payment.
- Reviewed if certain CPT codes will requiree Prior Authorization for future Medical procedures and surgeries including PA's for Durable Medical Equipment (DME)
- Faxed proof of eligibility documents to Providers to confirm Member enrollment. when needed after following HIPAA regulations and compliance, verified TAX ID from the requesting Provider to keep Member's information secured.
Education
High School Diploma -
John Marshall High School
3939 Tracy St. Los Angeles, CA06-1997
Skills
- Able to perform Eligibility verification
- Healthcare compliance
- Comfortable using most of Medical terminology
- Bilingual Spanish
- Typing speed 35-38 WPM
- Team collaboration
Timeline
Customer Service Agent
Centene Management Company
12.2017 - 04.2025
High School Diploma -
John Marshall High School