Pasig, National Capital Region, Philippines
As a dedicated Customer Service Advocate with nearly three years in healthcare sector, I excel in benefits and claims management, effective communication, and customer education. I am proficient in tools such as Microsoft Office, Google Workspace, Salesforce, and Canva, which enable me to deliver high-quality work in virtual environments. Holding a Bachelor of Science in Business Administration with a major in Marketing Management from Rizal Technological University, I am now eager to leverage my comprehensive expertise to support clients in streamlining their operations, enhancing customer satisfaction, and achieving their business objectives. Let's connect to explore how I can assist you in achieving your goals.
Release of Information, HIPAA Compliance
Assisted providers by responding to telephone promptly and accurately, addressing questions related to enrollment, benefit interpretation, and eligibility for medical care. Explained member plans of benefits, rights, and responsibilities in accordance with contracted arrangements, providing clear information on claim status, benefit coverage, and plan eligibility. Handled inbound and outbound calls to assist providers and members with medical and pharmacy benefits, eligibility, claim resolution, and dental and vision issues, promoting healthcare literacy. Checked if authorizations were required for the specific service or if there was already an authorization on file. Guided and educated customers about the fundamentals and benefits of consumer-driven healthcare topics to help them select the best benefit plan options and maximize the value of their health plan benefits. Acted as a single point of contact for members, explaining plan benefits, rights, and responsibilities, and providing information on claim status, benefit coverage, and plan eligibility. Resolved customer service inquiries and issues by identifying the topic and type of assistance needed, such as benefits, eligibility, and claims, ensuring first-call resolution. Provided accurate quotations of medical, dental, and vision benefits in accordance with appropriate plan provisions, ensuring members understood their coverage. Served as a liaison between members and healthcare providers, facilitating communication and ensuring members received necessary information regarding their benefits and claims.
Processed customer transactions efficiently, handling cash, credit, and debit payments accurately. Maintained a clean and organized checkout area to ensure a positive customer experience. Assisted customers with inquiries and provided information about products and store policies. Balanced cash drawers at the end of each shift, ensuring accurate accounting and reporting discrepancies. Handled returns and exchanges in accordance with store policies, providing refunds or store credit as appropriate. Promoted store loyalty programs and special promotions to enhance customer engagement and increase sales. Collaborated with team members to ensure efficient store operations and a seamless customer experience. Resolved customer complaints promptly, achieving a high level of customer satisfaction.