Summary
Overview
Work History
Education
Skills
Timeline
Generic

WENDY MARIE GUTIERREZ

San Antonio,TX

Summary

Dedicated professional customer service representative with 3+ years’ experience in a claim/call center environment. Motivated to maintain customer satisfaction and contribute to company success. Developed and implemented job aids and constantly updated policies to establish expectations and provide clear guidelines to ensure fair and consistent practices and legal compliance. Proven abilities to manage and complete high priority tasks while adapting to new environments. Successful at training and mentoring employees to promote culture of collaboration and continuous improvement. Motivated to learn, grow and excel in the role for commercial insurance.

Overview

6
6
years of professional experience

Work History

Service Advocate

Aetna/ CVS Health
03.2021 - Current
  • Mentored frontline CSR’s and helped guide Customer Service rep through systems, policies, member escalation and served as a subject matter expert on all Medicare related issues as well as the SME for dental inquiries for our department
  • Actively participates in team chats to help guide new hires
  • Leads huddles for our team
  • Selected to be apart of the We Speak Human project to enhance member experience by shifting our focus to member experience, disruption prevention, successful journeying, and root cause analysis
  • Selected to be the point of contact for the Healthy Rewards project to better understand the back-end systems and the communications that go out so that we know how to triage the members issues or inquiries regarding their benefit
  • Works closely with communication management to develop job aids and processes and to have policies updated for a smoother workflow and for better member experience
  • Selected to be apart of the task team to work complex member/CSR issues while sending coaching’s to representatives when needed
  • Constantly pulls and checks Verint to view ace scores and to keep track of meeting my daily/weekly/monthly metrics

Customer Service Representative /Dental Rep

Aetna/ CVS Health
10.2018 - 03.2021
  • Handled customer service inquiries and problems via telephone, internet, or written correspondence
  • Answers questions and resolves issues based on phone calls/letters from providers
  • Explained members benefits, rights, and responsibilities in accordance with contract to our providers
  • Educated providers on our self-service options, Assisted providers with credentialing and re-credentialing issues
  • Determined applicable coverage provisions and verified member plan eligibility relating to incoming correspondence and internal referrals
  • Handled incoming status requests for appeals and pre-authorizations not handled by Clinical Claim Management
  • Performed review of member/provider claim history to ensure accurate tracking of benefit maximums and or coinsurance/deductible
  • Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received
  • Handled customer service for dental plan inquiries
  • Accurately resolved dental claims and predetermination issues using HRP system
  • Triaged dental provider issues with verifying member eligibility and providing Medicare fee schedules when needed.

Administrative Assistant/Office Manager

Electronic Merchant Systems
San Antonio, TX
08.2016 - 10.2018
  • Restocked supplies and placed purchase orders to maintain adequate stock levels.
  • Coordinated travel arrangements by booking airfare, hotel and ground transportation.
  • Offered office-wide software support and training, troubleshooting issues and optimizing usage.
  • Managed Access databases converting complex data into easy-to-interpret data.
  • Interacted with vendors, contractors and professional services personnel to receive orders, direct activities and communicate instructions.
  • Coached new employees on administrative procedures, company policies and performance standards.
  • Scheduled office meetings and client appointments for staff teams.
  • Organized weekly staff meetings and logged minutes for corporate records.
  • Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
  • Arranged rapid office equipment repair and maintenance with vendors.
  • Maintained staff directory and company policy handbook for human resources department.

Front Desk Brokerage Administrator

Robert Half International, Marcus & Millichap Real Estate
San Antonio, TX
02.2016 - 08.2016
  • Provides telephone and other Administrative office and Brokerage support to the Agents and Management of the office also provided training to new Agents, Sales Assistants, Agent Assistants
  • Learn all software, company applications and policies/procedures that pertain specifically to Agents and Assistants and conduct training on software, including but not limited to: IMpact, Costar, LexisNexis, MNet,
  • MWEB, Mapnet, Intouch and Landvision
  • Rocess new listings to include proofing and editing for superior quality, downloading MNet system for Impact program
  • Create files and adhere to the company filing system
  • Assist Operations Manager in the processing of closing and under contract/solds when needed
  • Using Impact, data entry of new listings into MNet, create paper listings and work with Operations Manager to activate new listings in a timely manner
  • Performed other duties as assigned by Operations Manager or Regional
  • Anager.

Education

High School Diploma -

Jubilee Academic
San Antonio, TX
05.2006

Skills

    Project management

    Computer skills Microsoft word and Excel

    Critical Thinking

    Teamwork

    Problem Solving

    Excellent written and verbal communication skills

    Knowledgeable in Salesforce GPS and HRP

    Active listening

    Organizational and multitasking skills

    Mentoring and Coaching

Timeline

Service Advocate

Aetna/ CVS Health
03.2021 - Current

Customer Service Representative /Dental Rep

Aetna/ CVS Health
10.2018 - 03.2021

Administrative Assistant/Office Manager

Electronic Merchant Systems
08.2016 - 10.2018

Front Desk Brokerage Administrator

Robert Half International, Marcus & Millichap Real Estate
02.2016 - 08.2016

High School Diploma -

Jubilee Academic

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