Wendy Sanchez
Arlington,TX
Summary
Personable and dedicated Customer Service Representative with extensive experience in medical industry. Solid team player with upbeat, positive attitude and proven skill in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Articulate, enthusiastic and results-oriented with demonstrated passion for building relationships, cultivating partnerships and growing businesses. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
33
33
years of professional experience
Work History
Dental Customer Service
HGS - Hinduja Global Solutions
Arlington, TX
06.2022 - 12.2022
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Demonstrated excellent communication skills in resolving product and consumer complaints.
- Developed strong customer relationships to encourage repeat business.
- Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Escalated customer concerns, issues and requirements to supervisors for immediate rectification.
Case Manager
RemX, McKesson Specialty
Arlington, TX
10.2021 - 03.2022
- Maintained logs and electronic client records following department and agency policies for effective monitoring.
- Called on status of Prior Authorizations and updated status.
- Provided detailed notes of call.
Sr Claims Benefit Specialist/Examiner
Aetna, a CVS Health
Arlington, TX
01.1995 - 08.2021
- Adjusted reserves to maintain consistency with established operational and risk guidelines.
- Evaluated and investigated assigned claims to recommend workflows, alternate decisions and improvements to future claims handling.
- Identified cases with processing deficiencies or requiring higher-level support and coordinated management.
- Gathered information from various third parties to determine claim acceptability.
- Verified and analyzed claims settlement data to ensure validity.
- Conducted daily reviews on claim files and verified sending of status letters to policyholders.
- Investigated questionable claims to determine payment authorization.
- Analyzed and audited open claims to calculate additional payments owed.
- Examined claims investigated by independent adjusters.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Paid and processed claims within designated authority level.
- Completed required investigations on referred files within established timeframes.
- Double-checked and reviewed documentation for denied and accepted insurance claims.
- Reviewed claims to ensure accuracy, resulting in multiple claim reductions.
- Researched and followed up on denied insurance claims.
- Reviewed and resolved open claims and change orders to determine entitlement for additional payment.
- Maintained thorough understanding of fraudulent and illegal practices.
Pharmacy Technician
Eckerd Drugs
Grand Prairie, TX
12.1992 - 10.1994
- Teamed with peers, technicians and pharmacists to prioritize and complete orders.
- Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
- Verified prescriptions and drug labels, documents and packages.
- Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.
- Interpreted and processed medication orders under supervision of pharmacist.
- Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
- Prepared prescription transfers to other pharmacies.
- Transmitted claims to insurance companies for payment and reconciled EOBs.
- Improved inventory management procedures to reduce overhead, backorders and overstock.
- Leveraged database to confirm validity of prescriptions, patient data and drug side effects.
- Flagged potential side effects and allergies to prescribed medications for patients.
- Promoted supplement and nutritional products to maximize sales and customer wellness.
- Answered telephones to respond to questions or requests.
- Entered prescription information into computer databases.
- Operated cash registers to accept payments from customers.
- Assisted customers by answering questions, locating items or referring to pharmacist for medication information.
- Greeted customers and answered questions regarding personal medications or over-the-counter pharmacy products.
- Cleaned and maintained equipment or work areas according to prescribed methods.
- Ordered, labeled and counted stock of medications and entered inventory data into computer.
- Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
- Prepared and processed medical insurance claim forms and records.
Food and Beverage Server
Six Flags Over Texas
Arlington, TX
03.1990 - 12.1992
- Handled food safely and kept spaces clean to protect customers from foodborne illness and maintain proper sanitation.
- Provided exceptional service to high volume of daily customers.
- Stocked server areas with supplies before, during and after shifts.
- Completed opening and closing checklists to ensure smooth restaurant operations.
- Maintained accuracy while handling payments, giving change and printing receipts for customers.
- Addressed concerns quickly to improve customer experience and escalated issues to management for resolution when necessary.
- Verified guest satisfaction with meals and suggested additional items to increase restaurant sales.
Education
Some College (No Degree) - General Studies
Mountain View Junior College
Dallas, TXSkills
- Staff Training
- Customer Service
- Microsoft Excel
- Documentation
- Multi-Task Management
- Active Listening
- Client Relations
- Coordination
- Team Development
- Problem Resolution
- 10-Key
- Call Triaging
- Data Evaluation
- Proofreading
- Microsoft Outlook
- System Implementation
- Data Entry
- Research
- Product Organization
- Product Knowledge
- Customer Relations
- High-Energy Attitude
- Call Center Operations
- Spreadsheets
- Inbound and Outbound Calling
- Medical Terminology Knowledge
- Report Generation
- Report Preparation
- Complaint Resolution
- Microsoft Office Expertise
- Researching
- Positive and Professional
- Computer Proficiency
- Creative Problem Solving
- Data Collection
- Courteous Demeanor
- Stockroom Procedures
- Conflict Resolution
- Adaptive Team Player
- Information Security
- Business Development Understanding
- Professional Telephone Demeanor
- Report Creation
- Microsoft PowerPoint
- Problem-Solving Abilities
- Retail Sales Customer Service
- Office Equipment Proficiency
- Grammar
- Shipping and Receiving Understanding
- Conflict Mediation
- Prioritization
- Document Control
- Quality Assurance Controls
- Reading Comprehension
- Critical Thinking
- Customer Consulting
Languages
English
Native/ Bilingual
Timeline
Dental Customer Service
HGS - Hinduja Global Solutions
06.2022 - 12.2022
Case Manager
RemX, McKesson Specialty
10.2021 - 03.2022
Sr Claims Benefit Specialist/Examiner
Aetna, a CVS Health
01.1995 - 08.2021
Pharmacy Technician
Eckerd Drugs
12.1992 - 10.1994
Food and Beverage Server
Six Flags Over Texas
03.1990 - 12.1992
Some College (No Degree) - General Studies
Mountain View Junior College
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