Valeria Vargas

• Support healthcare-related inquiries and operational processes involving members, providers, claims, benefits, and third-party administrators.
• Research complex issues and review claim and benefit information to identify discrepancies and determine appropriate next steps.
• Communicate professionally with internal teams, providers, and external partners to resolve issues and obtain required information.
• Review healthcare documentation and payment information for accuracy and completeness.
• Coordinate with multiple parties to address escalations and time-sensitive requests.
• Explain healthcare and insurance information in a clear, professional manner.
• Maintain accurate documentation while handling confidential member and healthcare information.
• Apply knowledge of medical terminology, healthcare processes, HIPAA requirements, and insurance operations.
• Identify issues requiring correction and communicate recommendations clearly to appropriate departments or partners.
• Manage multiple cases and priorities while meeting productivity, quality, and turnaround expectations.
• Work effectively in a remote environment while maintaining communication, organization, and attention to detail.

• Answering broker questions about members, benefits, eligibility, and claims
• Researching and resolving account or enrollment issues
• Explaining plan information and benefit details
• Assisting with enrollment and eligibility
• Communicating with internal departments to resolve problems
• Handling escalated or time-sensitive requests
• Documenting interactions and maintaining accurate records
• Providing professional customer service by phone, email, or online systems
• Working with brokers, employers, members, and healthcare teams

• Contact or receive calls from members considering leaving their health plan.
• Listen to complaints and understand why the member is dissatisfied.
• Explain benefits, services, and available options.
• Research eligibility, coverage, billing, or account concerns.
• Resolve problems or connect the member with the appropriate department.
• De-escalate difficult conversations.
• Educate members about resources that may help them.
• Document interactions in the member’s account.
• Follow up on unresolved concerns.
• Meet retention, quality, productivity, and customer-satisfaction goals

Medical Office / Healthcare Training

• Medical Terminology
• ICD-9 Coding
• HIPAA
• OSHA
• Medical Office Procedures