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Customer Service Specialist with 5+ years in healthcare and client support
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Competencies
Provided high-quality support handling healthcare plan inquiries, claims concerns, and patient access management.
Mentored new team members and supervised quality monitoring, enhancing team effectiveness and operational standards.
Effectively communicated complex information with clarity to members, healthcare providers, and team members.
Utilized various system tools to manage high-volume scheduling, claims, and enrollment discrepancies efficiently.
Ensured adherence to healthcare regulations including HIPAA during all operations, both locally and internationally.
Education
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Summary
Dedicated customer service agent with 5+ years in healthcare, specializing in complex inquiries, compliance, and team mentorship. Experienced in global deployments, ensuring service excellence and regulatory adherence across diverse settings.
Key Achievements
- Handled complex healthcare inquiries, ensuring compliance with HIPAA and accuracy in resolving member issues.
- Mentored new hires and trained trainees in claims handling, compliance, and customer service best practices.
- Participated in international deployment to the Philippines, establishing a new site aligned with US healthcare standards.
Experience
Customer Service Agent
Assist members with general inquiries about their healthcare plans, Ensure every interaction is handled with accuracy, empathy, and compliance based on company policies such as HIPAA, Assist members with claims concerns, verifying benefits with accuracy and efficiency, Explain denials, billing...
Subject Matter Expert
Mentor new hires and upskill trainees on sharing best practices for handling complex claims and compliance processes, Act as the primary point of contact for escalated customer issues requiring expert resolution, Perform on 2 deployments to Philippines during October 2024 until July 2025 for...