Victor Garcia Jr
Long Beach,CA
Summary
A highly motivated, confident individual with exceptional multi-tasking capabilities and able to work in a target driven, high paced environment. Hardworking with excellent attendance and punctuality records who can work equally well alone or as part of a team. Can communicate effectively with people from diverse backgrounds and would be an asset to any employer. Motivated individual with experience in customer service and sales. Skilled in building customer relationships and understanding customer needs. Strong communication and interpersonal skills for providing superior customer service. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
8
8
years of professional experience
Work History
Provider Grid Ops Senior Specialist
Network Medical Management
01.2023 - Current
- Validate and uphold the integrity of provider database adhering to SB-137 compliance
- Act as liaison between internal departments (Contracting, Credentialing, Provider Relations, Terms and Conditions, Eligibility) and external (Health Plans) entities to effectively communicate and follow-up in a timely manner to resolve provider inquiries and requests
- Verify contract rates and/or fee schedule input correctly for vendors and providers
- Review providers add, termination, and demographic update requests.
Provider Grid Ops Coordinator
Network Medical Management
01.2020 - 12.2022
- Validate and uphold the integrity of provider database adhering to SB-137 compliance
- Act as liaison between internal departments (Contracting, Credentialing, Provider Relations, Terms and Conditions, Eligibility) and external (Health Plans) entities to effectively communicate and follow-up in a timely manner to resolve provider inquiries and requests
- Verify contract rates and/or fee schedule input correctly for vendors and providers
- Review providers add, termination, and demographic update requests.
Customer Service Rep.
Optum
08.2019 - 01.2020
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
- Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
Member Services
Molina Healthcare
10.2017 - 08.2019
- Responds to incoming calls from members and providers excluding provider claims calls
- Accurately records all calls as applicable
- Achieves individual performance goals as it relates to call center objectives
- Assists callers with Web Portal registration and utilization.
Customer service rep.
AAA
09.2015 - 08.2017
- Request pertinent information and enter data into an automated dispatch system with a high degree of accuracy
- Respond to members regarding arrival times, delays, products or services, and policies
- Utilize problem-solving skills to satisfy member requests and/or complaints.
Education
High School Diploma -
Phineas Banning Senior High School
Wilmington, CA06.2003
Skills
- Customer Relations
- Proficient in Microsoft office
- Idea Development and Brainstorming
- Improvement plan knowledge
- Analytical Thinking
- Critical Thinking
- Problem Resolution
- Social Perceptiveness
Languages
Spanish
Full Professional
Timeline
Provider Grid Ops Senior Specialist
Network Medical Management
01.2023 - Current
Provider Grid Ops Coordinator
Network Medical Management
01.2020 - 12.2022
Customer Service Rep.
Optum
08.2019 - 01.2020
Member Services
Molina Healthcare
10.2017 - 08.2019
Customer service rep.
AAA
09.2015 - 08.2017
High School Diploma -
Phineas Banning Senior High School
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