CazVid - Video Resumes That Work
CazVidEste é o meu perfil
ENESPT
Contato pela CazVid

Este perfil está escrito em espanhol

D

Denisse

Inbound Contact Representative

Contato

San Juan, San Juan, Puerto Rico
Disponível na CazVid
Contato pela CazVid

Competências

Bilingual: English & Spanish

Experiencia demostrada en Bilingual: English & Spanish.

Medicare/Medicaid Customer Support

Experiencia demostrada en Medicare/Medicaid Customer Support.

Grievance & Appeals Case Processing (CMS Compliance)

Experiencia demostrada en Grievance & Appeals Case Processing (CMS Compliance).

Claims & Documentation Management

Experiencia demostrada en Claims & Documentation Management.

Call Center Operations

Experiencia demostrada en Call Center Operations.

Formação acadêmica

Bachelor’s Degree, Nursing
Nuc University, Bayamón
Completado 2024
Bachelor’s Degree, Science
Bayamon Central University
Completado 2014

Idiomas

EnglishBilingual
SpanishBilingual

Resumo

Inbound Contact Representative buscando nuevas oportunidades

Experiência

Grievances and Appeals Representative (Expedite / Pre-Service)

Humana
Ene 2024 - Presente

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

Humana CarePlus
Ene 2020 - Ene 2023

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

Triple-S Salud, Inc.
Ene 2017 - Ene 2020

Responded to member inquiries in English and Spanish.. Assisted with claims, billing issues, and service requests.. Maintained accurate documentation and case handling.

Service Representative

Triple-S Advantage, Inc.
Ene 2015 - Ene 2017

Delivered customer support to Medicare Advantage members.. Provided information on policies and benefits.. Escalated and resolved member concerns.

Customer Service Associate

Bed Bath & Beyond
Ene 2003 - Ene 2014

Calculated store inventory and supported Bridal Registry operations.. Managed cash register and processed transactions accurately.. Communicated and engaged with customers to ensure satisfaction.

Habilidades

Bilingual: English & SpanishMedicare/Medicaid Customer SupportGrievance & Appeals Case Processing (CMS Compliance)Claims & Documentation ManagementCall Center Operations
Publicado na CazVid - 1 de nov. de 2026
Contato Denisse