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Denisse
Inbound Contact Representative
Contact
Competencies
Experiencia demostrada en Bilingual: English & Spanish.
Experiencia demostrada en Medicare/Medicaid Customer Support.
Experiencia demostrada en Grievance & Appeals Case Processing (CMS Compliance).
Experiencia demostrada en Claims & Documentation Management.
Experiencia demostrada en Call Center Operations.
Education
Languages
Summary
Inbound Contact Representative buscando nuevas oportunidades
Experience
Grievances and Appeals Representative (Expedite / Pre-Service)
Manage expedited and pre-service grievance and appeal cases.. Ensure timely resolution in compliance with CMS standards.. Collaborate with providers and internal departments to resolve member concerns.
Inbound Contact Representative
Answer calls from CarePlus Health Plan members regarding medical coverage.. Assist members with eligibility, benefits, and provider inquiries.. Resolve grievances and escalate cases when necessary.. Educate members on their coverage and ensure accurate documentation of calls.. Provided bilingual (English/Spanish) support for member inquiries.. Assisted with coverage, claims, and provider-related requests.. Maintained compliance with Medicare and CMS regulations.
Service Representative
Responded to member inquiries in English and Spanish.. Assisted with claims, billing issues, and service requests.. Maintained accurate documentation and case handling.
Service Representative
Delivered customer support to Medicare Advantage members.. Provided information on policies and benefits.. Escalated and resolved member concerns.
Customer Service Associate
Calculated store inventory and supported Bridal Registry operations.. Managed cash register and processed transactions accurately.. Communicated and engaged with customers to ensure satisfaction.