Dedicated Nursing Student with clinical experience in patient care and medication administration. Proficient in conducting assessments and addressing diverse patient needs while ensuring safety and professionalism. Prepared to leverage clinical knowledge to support healthcare teams and enhance patient outcomes.
1
Certification
9
years of professional experience
Work History
Member Service Representative
2 Years 9 Months
Cenetene | Work From Home | 11.2023 - 08.2026
Resolved member inquiries regarding Medicaid benefits, eligibility, claims, and prior authorization requirements.
Documented calls and case notes accurately in CRM and claims systems to support compliant follow-up.
Coordinated issue resolution with providers, care teams, and internal departments to remove service barriers.
Interpreted plan coverage details and communicated benefit information in clear, member-friendly language.
Guided members through enrollment, coverage changes, and access to behavioral and medical services.
Escalated complex grievances and appeals while maintaining service standards and regulatory compliance.
Reviewed account and claim records to identify discrepancies and correct processing errors.