Chelsea Marquez
Fortuna
Sacramento
1
Certification
10
years of professional experience
Customer service professional supporting high-volume inbound and outbound contact across banking, health plan, and online service environments, aligning with Senior Customer Service Representative work. Handles escalations, account questions, and documentation with accurate call notes and clear handoffs. Brings customer resolution, account servicing, and cross-channel support from regulated service roles.
Work History
PT Customer Service Rep
6 Months- Take inbound calls, 20 - 40 per day.
- General information/Billing department for FFS (Fee For Service) Medicaid-Medi-Cal.
- Answer general questions, such as providing county or other general numbers to the member.
- Provide info on member's current coverage, or claims history going back 12 weeks. (active or inactive, when coverage ended or when it begins)
- Submit OHC (other health coverage) removal requests.
- Advise on how to search for FFS provider.
- Advise the member if they are FFS or enrolled in a MCP, and what the next steps are if I cannot directly assist them.
- Cold transfer to provider line if needed.
Online Services Rep
2 Months- Handled [number] inbound calls daily from clients, branches, and financial advisors regarding online account support.
- Resolved password resets, EFT PINs, enrollment questions, and tax form requests for online account users.
- Guided customers through mobile deposit, account transfers, and online navigation issues using clear step-by-step support.
- Escalated technical issues and unresolved cases to the appropriate departments for specialized follow-up.
- Maintained accurate call notes and followed required service metrics throughout each interaction.
- Supported clients with online account questions while keeping service responses organized and professional.
FEP Customer Care
6 Months- Resolved provider inquiries and appeals by documenting outcomes, closing cases, or routing them for further review.
- Processed prior authorization requests for outpatient and inpatient services according to established authorization lists.
- Verified eligibility and benefits to support accurate member service decisions and timely case handling.
- Processed incoming faxes within established standards and entered authorization details into the system.
- Used ICD-9 codes and available resources to complete cases correctly and support cost-effective medical service review.
Care Gap Closure Support Specialist
3 Months- Completed 65 daily calls to support care gap closure outreach and member follow-up.
- Answered phone queues and routed member inquiries with timely, professional service.
- Explained care gap requirements to commercial members and reduced confusion around next steps.
- Scheduled appointments and followed up on upcoming visits to support closure of outstanding gaps.
- Documented all member contacts in spreadsheets and Facets for accurate tracking and continuity.
Clinical Support Coordinator
11 Months- Communicated claim outcomes by email and fax to support timely coordination across departments.
- Used Excel to gather provider and facility information for claims research and daily work logs.
- Maintained corrections for claims older than 30 days and kept records current for follow-up.
Customer Service Representative
4 Months- Answered general CDC vaccine questions and directed callers to official website information when additional clarification was needed.
- Screened callers for state incentive eligibility through eligibility verification questions and explained qualification requirements clearly.
- Resolved redemption questions and code issues while maintaining accurate call logging for follow-up support.
Outbound Customer Rep Level 2
6 Months- Handled 40-60 outbound calls daily to DMV offices for title correction status.
- Processed odometer statement faxes and routed them for timely account updates.
- Documented each call thoroughly to maintain accurate account histories and follow-up notes.
- Used Microsoft Excel to organize account details and track daily status updates.
Tier 1 Customer Service Rep
2 Months- Guided customers through account setup steps and resolved login issues with clear, patient communication.
- Explained website navigation options and troubleshooting steps to help customers complete tasks independently.
- Responded to general questions promptly while maintaining a professional and courteous service experience.
- Logged customer interactions in Facets and call logging systems to keep records accurate and organized.
- Used Microsoft Excel, Outlook, and MS Word to track communication and support daily service work.
Customer Care Representative
4 Months- Managed pharmaceutical inquiries related strictly to prescription medications with accurate, timely member support.
- Started prior authorizations and coverage determinations while following established payer and plan procedures.
- Processed test claims and overrides for pharmacies to support accurate benefit verification and adjudication.
- Clarified coverage, copays, premiums, and other plan details to help members understand their benefits.
- Transferred complex inquiries to the appropriate departments to maintain efficient resolution paths.
Member Service Representative
4 Months- Handled up to 80 inbound and outbound calls per day, supporting mortgage, student loan, and auto loan payments.
- Processed merchant fraud disputes tied to credit cards, documenting issue details and following established resolution steps.
- Supported checking, savings, certificate, loan, and open line of credit inquiries with clear, accurate account guidance.
- Guided members through online payment setup and follow-up questions using Facets for account review and service details.
- Handled escalated calls calmly, de-escalating concerns and keeping conversations focused on timely member resolution.
Member Services Representative
3 Months- Verified eligibility and coverage details for employer and personal health plans before responding to member questions.
- Assigned primary care physicians and updated member account records to reflect benefit selections accurately.
- Supported prior authorization requests for medications and procedures, guiding members through required steps.
- Documented member interactions in Facets and call logging systems to maintain accurate service records.
- Maintained confidentiality standards and HIPAA compliance while delivering accurate information in line with performance goals.
Phone Banker
4 Months- Supported business banking needs through online banking guidance, check ordering, and debit and credit card servicing.
- Handled escalated calls with a friendly, respectful approach while delivering clear answers and practical next steps.
- Followed strict compliance procedures when processing requests and account changes for business customers.
- Recommended banking products based on customer needs and service history.
- Delivered consistent follow-through so customers received complete resolutions without repeat calls.
Education
High school diploma - Psychology Major
Skills
Facets
Claims processing
Prior authorization
Eligibility verification
Appeals processing
Microsoft Excel
Outlook
MS Word
Windows
Call logging
Certification
Sterile Tech Processing Certification
Timeline
PT Customer Service Rep
Fortuna
05.2026 - CurrentRead More
Online Services Rep
Cognizant UBS/Nityo
01.2026 - 03.2026Read More
FEP Customer Care
Wollborg Michelson/Blue Shield Of California
02.2024 - 08.2024Read More
Care Gap Closure Support Specialist
Wollborg Michelson/Blue Shield Of California
09.2023 - 12.2023Read More
Clinical Support Coordinator
Wollborg Michelson/Blue Shield Of California
04.2022 - 03.2023Read More
Customer Service Representative
MMC Group L.P./Maximus
09.2021 - 01.2022Read More
Outbound Customer Rep Level 2
Dealertrack/Ranstad
07.2020 - 01.2021Read More
Tier 1 Customer Service Rep
EDD/Mattson Resources
06.2020 - 08.2020Read More
Customer Care Representative
EnvisionRXOptions/Everstaff
02.2019 - 06.2019Read More
Member Service Representative
First Tech Federal Credit Union/SearchPros Staffing
01.2018 - 05.2018Read More
Member Services Representative
Blue Shield Of California
03.2017 - 06.2017Read More
Phone Banker
Wells Fargo
11.2016 - 03.2017Read More
American River College
High school diploma from Psychology Major
Read More