Vanessa Gamboa
Houston,TX
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
17
17
years of professional experience
Work History
Customer Service Advocate
Centene Corporation
03.2024 - Current
- Answer and manage inbound inquiries from customers regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics
- Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations
- Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance
- Adhere to all applicable department, organization and/or regulatory policies and procedures while making sure the members still receive quality customer service.
Express Claims Associate
State Farm Insurance Companies
12.2022 - 09.2023
- Primarily answer inbound claims as well as make outbound calls to customers and claimants
- Proactively investigate claims, establish liability, apply coverage and pay amounts owed
- Other duties consist of locating claimant information such as claimant's insurance company to set up claim for State Farm to subrogate against claimant's insurance company to recoup funds State Farm paid out.
Bilingual Loss Reporting Agent
AppleOne Staffing
08.2022 - 12.2022
- Receive inbound calls from customers with various insurance companies that are needing to file auto, home property or worker's compensation claims
- Responsible for gathering facts of loss, inputting data into computer system and providing additional information to caller in regards to next steps in claims process
- Other duties consist of making sure protocols for each individual insurance company are followed as each one has different policies and procedures.
Member Services Representative
Randstad Staffing Agency
04.2022 - 07.2022
- Answer and manage inbound inquiries from customers regarding health plan benefits and claims, eligibility, medical and other healthcare procedures, billing and payments and other related topics
- Handle and process customer complaints/ grievances while applying appropriate conflict management skills to de-escalate potentially stressful situations
- Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance
- Adhere to all applicable department, organization and/or regulatory policies and procedures while making sure the members still receive quality customer service.
Senior Patient Access Representative
UT Health Science Center
07.2019 - 06.2020
- Obtains demographic, insurance and financial information from patient or guarantor
- Enters information in computer system with a high degree of accuracy
- Schedule patient appointments and enter required information in the computer system in an accurate and timely manner
- Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required time frames.
Supplemental Patient Access Representative
Memorial Hermann Health System
02.2019 - 06.2019
- Schedules patient appointments and enters required information in the computer system in an accurate and timely manner
- Obtains demographic, insurance and financial information from patient or guarantor and enters information in computer system with a high degree of accuracy
- Communicates in an effective and professional manner with Physicians, ancillary departments, nursing units, physicians' office staff, insurance companies, as well as patients and their families
- Completes thorough and accurate documentation and advised patient of necessary preparation for procedure scheduled as well answer any questions patient may have.
Scheduler/Member Services Representative
Texas Children's Health Plan
12.2015 - 01.2019
- Answer telephone promptly and in a polite and professional manner to schedule patient appointments within Epic system
- Schedule appointment correctly - review appointment date, time, location, and provider name with caller as well as inform caller of items to bring to appointment such as insurance card, medications, office visit fee and verification of income - if applicable
- Remind caller to arrive 15 to 30 minutes before scheduled appointment time to complete paperwork and advised caller of cancellation/no show policy
- Also obtain and enter accurate demographic information into Epic and Touchpoint (address, telephone number, name of insurance or self-pay status) as well as answer questions and offer other information, as requested, to provide patient-focused service and a positive impression of the organization.
Customer Service Representative
Centerpoint Energy
01.2014 - 09.2014
- Receives and responds to customer inquiries, complaints or sales/promotional opportunities for CenterPoint Energy gas and/ or electric customers in a fast paced, high call volume environment
- Performs direct customer contact through various channels including phone, email and chat
- Completes administrative functions and data entry
- Responds to all questions relating to all Company customer service inquiries via verbal and/or written communication with a focus on one call resolution
- Issues orders to establish or discontinue gas service or to establish Electric Service Identifier (ESID) number to create meter sets
- Resolves billing inquiries, performs account adjustments, negotiates payment arrangements and deposit amounts and follows-up on customer accounts.
Customer Service Representative
Entrust Energy (Primary Services Temp Agency)
06.2013 - 12.2013
- Answer high volume of incoming customer calls within a call center environment while utilizing multiple databases and resources
- Residential and commercial account inquiries include but not limited to: general billing, product description, service inquiry, payment processing, negotiation of extensions and deferred payment plans, add/remove market holds, process move-in, move-out, transfer of service, and switch transactions, high bill inquiries, conservation discussions, and other transactions
- Report power outages to transmission and Distribution Utilities (TDUs)
- Analyze customer accounts, determine appropriate resolution and provide customer callbacks as necessary
- Process returned mail, faxes, email requests, correspondence and other customer support duties may be required.
Customer Service Representative
O'Connor & Associates (AppleOne Temp Agency)
04.2012 - 06.2012
- Answered phones to new and existing customers in regards to hearing processes and results, invoices and customer's complaints
- Also provided customers with product and service information as well as up sold services, added new clients to the system and performed save attempts on clients that were not happy with the service provided
- Other duties consisted of identifying, researching and resolving customer issues using computer systems and following up on customer inquiries not immediately resolved.
Customer Service Representative
Planned Parenthood
03.2011 - 12.2011
- Answers telephones, makes and confirms appointments appropriately and accurately, both on the phone and in the appointment system for the Family Planning, Teen, Dysplasia and abortion providing clinics
- Provides accurate information on birth control methods, sexually transmitted diseases, including HIV, pregnancy testing, abortion services and reproductive health care, in response to client questions
- Other duties consistent of assisting clients with questions intended for physicians/clinicians as needed and accurately recording/assigning those questions in EMR, helping to maintain client records, filing systems (WHP Screening tools) data systems, client logs including abnormal follow-up, record transfers and Electronic Medical Records (EMR).
Risk Operations Analyst
JP Morgan Chase
11.2007 - 08.2010
- Took inbound calls from Chase customers that have a deposit hold on a check that was deposited into their bank account
- Advised customer of why the item is being held and attempt to call the financial institution that the check is drawn off or the maker of the item to verify the validity of the item
- Released the hold if the item was able to be verified and advised customer of this info as well as the balance that is reflected in their acct once the hold was released
- Other calls taken were from customers that have their Chase online access deactivated, advised these customers of why the access was blocked and what steps are necessary to restore it
- Also responsible for assisting the Chase branches identify counterfeit items that Chase customers or non customers were trying to cash and or deposit.
Education
Skills
- Call center experience
- Complaint resolution
- Data Entry
- Problem-solving abilities
- Appointment Setting
- Professional telephone demeanor
- Medical terminology knowledge
- Microsoft Office Suite
Timeline
Customer Service Advocate
Centene Corporation
03.2024 - Current
Express Claims Associate
State Farm Insurance Companies
12.2022 - 09.2023
Bilingual Loss Reporting Agent
AppleOne Staffing
08.2022 - 12.2022
Member Services Representative
Randstad Staffing Agency
04.2022 - 07.2022
Senior Patient Access Representative
UT Health Science Center
07.2019 - 06.2020
Supplemental Patient Access Representative
Memorial Hermann Health System
02.2019 - 06.2019
Scheduler/Member Services Representative
Texas Children's Health Plan
12.2015 - 01.2019
Customer Service Representative
Centerpoint Energy
01.2014 - 09.2014
Customer Service Representative
Entrust Energy (Primary Services Temp Agency)
06.2013 - 12.2013
Customer Service Representative
O'Connor & Associates (AppleOne Temp Agency)
04.2012 - 06.2012
Customer Service Representative
Planned Parenthood
03.2011 - 12.2011
Risk Operations Analyst
JP Morgan Chase
11.2007 - 08.2010
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