Elizabeth Martin-Maciel
Upland
Summary
Reliable Customer Service Representative known for high productivity and efficient task completion. Specialized in communication, problem-solving, and time management skills, ensuring smooth operations in customer service environments. Excel in listening, empathy, and patience, which are crucial for addressing customer needs effectively and building positive relationships.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Customer Service Representative
San Francisco Health Plan
San Francisco
07.2023 - Current
- Provided exceptional customer service to ensure customer satisfaction.
- Maintained a high level of professionalism when dealing with difficult customers.
- Provided education on the appeals process to members and providers as needed.
- Collaborated with health care providers and members to resolve issues in a timely manner.
- Provided customer service support to patients regarding their authorization inquiries.
- Researched insurance coverage details for patients to determine authorization requirements.
- Coordinated with various departments such as billing, coding, and clinical teams to obtain necessary documentation for authorization submissions.
- Provided customer service support to policyholders, claimants, and agents over the phone or via email.
Member Service Representative
Inland Empire Health Plan, Care Management
Rancho Cucamonga
06.2019 - 07.2023
- Educated members on Medi-Cal benefit coverage and eligibility guidelines to enhance understanding of health plans.
- Advocated for members by addressing inquiries regarding eligibility, authorizations, and care access.
- Participated in LEAN initiatives, driving process improvement projects and promoting Voice ID and Rapid Improvement Events.
- Achieved monthly scores including Quality Assurance scores and Average Handle Time.
- Managed high call volumes while ensuring timely data entry and documentation accuracy.
- Demonstrated strong problem-solving skills, effectively managing time with minimal supervision.
- Handled escalated calls with professionalism, diffusing challenging situations to maintain member satisfaction.
Medical Assistant
Byran P. Chan
Upland
02.2015 - 06.2019
- Answered incoming calls, scheduled appointments, and provided general information to callers.
- Maintained confidentiality of patient information according to HIPAA guidelines.
- Provided support with front desk duties such as checking in patients, collecting copayments and deductibles, answering phones.
- Ensured all necessary paperwork was completed prior to patient visits.
- Maintained accurate medical records including filing, retrieving, scanning, copying and faxing documents as requested by physicians or staff members.
- Processed payments for services rendered accurately and efficiently.
- Provided assistance to clinicians during exams when needed.
- Verified insurance eligibility and collected copays and deductibles at time of service.
- Assisted with scheduling follow-up appointments and referrals as requested by providers.
- Retrieved faxes and uploaded documents to patient charts to assist clinical staff.
- Filed insurance claims forms in accordance with applicable regulations.
- Entered data into electronic medical record system accurately and efficiently.
- Reviewed authorization requests for accuracy and completeness.
- Processed prior authorization requests in accordance with departmental guidelines.
Education
High School Diploma -
Upland High School
Upland 06-2016
Some College (No Degree) - Nursing
Riverside Community College
Riverside, CASkills
- Customer service
- Problem solving
- Insurance verification
- Data entry
- Call handling
- Healthcare knowledge
- Documentation accuracy
- Team collaboration
- Medical terminology
- Spanish fluency
Certification
- Medical Assistant Certificate
Timeline
Customer Service Representative
San Francisco Health Plan
07.2023 - Current
Member Service Representative
Inland Empire Health Plan, Care Management
06.2019 - 07.2023
Medical Assistant
Byran P. Chan
02.2015 - 06.2019
High School Diploma -
Upland High School
Some College (No Degree) - Nursing
Riverside Community College
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