Veronica Avina
Dallas,TX
Summary
Service-oriented professional with an entry level background in health care, insurance, finance and hospitality.
Dependable team player, with effective communication and organizational skills. My goal is to employ my skillset towards a challenging and fulfilling role!
Overview
9
9
years of professional experience
Work History
Healthcare Customer Service Representative
TTEC
05.2024 - 09.2024
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Conducted health screenings and assessments to identify health needs and risk factors for individuals and communities.
- Promoted available resources and connected individuals with services.
- Overcame objections with deep knowledge of membership benefits, scripted responses and persuasive communication skills.
- Assisted in management of patient utilization of health care system and provided patient education relative to health care needs, use of community resources and responsibilities of membership in managed care.
Healthcare CSR
ImageNet Consulting
11.2023 - 05.2024
- Managed incoming phone calls to resolve patient inquiries and refer calls to appropriate departments.
- Assisted patients in understanding how insurance coverage works and calculated copays.
- Interacted with several insurance companies to verify patient eligibility and benefits.
- Resolved discrepancies with client applications to verify eligibility.
- Scheduled appointments with applicants to gather information and explain benefits processes.
- Answered provider inquiries via email, telephone and written correspondence.
- Registered and verified patient records before triage with most up-to-date information.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
Merchant Care Specialist
American First Finance
04.2023 - 08.2023
- Assist merchants with questions regarding merchant portal, troubleshooting, application assistance, rendering decisions, and sale finalization.
- Assist customers with questions regarding application assistance, rendering decisions, troubleshooting, and anything else related to the support of the customer during the application process.
- Assist merchants with facilitation of the underwriting process.
Member Services Specialist
Aetna
03.2018 - 07.2020
- Verified insurance coverage information (including patients' financial responsibility estimate) and updated PCP requests.
- Reviewed benefit info, by verifying CPT codes, and outlining any potential prerequisites, such as Prior Authorization Requests, Referrals, or Step Therapy.
- Assisted members and providers with billing queries and pharmacy requests.
- Assisted members with our network directory to locate providers.
- Assisted members and providers with Prior Authorization Requests and Appeals.
Claims Support Specialist
Eberl Claims
06.2017 - 03.2018
- Worked productively in a fast-moving work environment to process a large volume of claims.
- Provided members with provisional guidance, following any catastrophic claim.
- Assisted displaced customers with lodging accomodations, due to uninhabitable conditions.
- Triaged callers to the appropriate department, as needed.
- Followed up with customers on unresolved issues.
ILR Claims Associate
Alacrity Services
12.2015 - 04.2017
- Used claims system tracker to document loss information for, both, auto and fire lines.
- Calculated adjustments, premiums and refunds.
- Calculated total loss vehicles and made salvage arrangements.
- Dispatched towing requests, arranged car rentals, and scheduled inspection or repair appointments.
Reservation Agent
G6 Hospitality
04.2015 - 08.2015
- Answered incoming phone calls and developed friendly rapport with callers while answering questions, making recommendations, and leading conversations to bookings.
- Provided customers with information about availability and pricing.
- Resolved various issues and discrepancies for customers.
- Prepared customer invoices, accepted payments, and processed refund and cancellation requests.
Education
Some College (No Degree) - Public Health
The University of Texas At Arlington
Bachelor of Science - Health Administration
Western Governors University
03.2025
Associate of Science -
Brookhaven College
03.2017
Skills
- Active Listening Skills
- Microsoft Office
- QuickBooks Knowledge
- Data Entry
- Vendor Invoice Processing
- Accounting Ledger Maintenance
- Medical Terminology
- HIPAA Compliance
- Insurance Claims - Auto & Fire
- Fluent in Spanish
- Call center experience
- Eligibility Determination
- Team Collaboration
Timeline
Healthcare Customer Service Representative
TTEC
05.2024 - 09.2024
Healthcare CSR
ImageNet Consulting
11.2023 - 05.2024
Merchant Care Specialist
American First Finance
04.2023 - 08.2023
Member Services Specialist
Aetna
03.2018 - 07.2020
Claims Support Specialist
Eberl Claims
06.2017 - 03.2018
ILR Claims Associate
Alacrity Services
12.2015 - 04.2017
Reservation Agent
G6 Hospitality
04.2015 - 08.2015
Some College (No Degree) - Public Health
The University of Texas At Arlington
Bachelor of Science - Health Administration
Western Governors University
Associate of Science -
Brookhaven College
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