Maria Ramirez
Long Beach
Summary
Experienced in customer service and healthcare support 8 years of experience, bringing strong communication, adaptability, and data management skills to enhance service delivery. Skilled in complaint handling and insurance verification, while maintaining confidentiality standards. Offers proficiency in CRM software and Microsoft Excel to streamline operations and improve customer satisfaction.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Customer Service Representative
Molinahealthcare
Long Beach
12.2017 - 02.2026
- Handled over 80+ calls daily related to eligibilty claims, prior authorization,pharmacy inquiries reducing average handle time and handling first call resolution
- used Salesforce, CRM and QNXT to document member interactions , track case progress.
- used QNXT to verify eligibility , review claims and update member records.
- Resolved an average of 45+member inquiries per day via email or via TWSM ensuring accurate explanation of coverage copays, and prior authorization requirements
- Processed eligibility updated with 99.2% accuracy reducing claims denials
- Completed all assigned task within required turn around times , Maintaining Accuracy and Quality
- Collaborated with healthcare teams to address member issues effectively.
- Handled member inquiries regarding medical benefits ,Medical Approvals and pharmacy claims with accuracy and empathy.
- Assisted members with medical claims , coverage determinations and explanation of benefits (EOB )details to ensure clarity and timely issue resolution.
- Effectively handled customer complaints and inquiries in a courteous a efficient manner.
- Maintained PHI records entered and updated members protected health information (PHI) And power of attorney documentation in internal systems with a high level of accuracy and confidentiality.
- Procesessed PCP request for member and id request
Medical Assistant
Teresa Bondoc Md
Long Beach, CA
10.2015 - 12.2017
- Manage an average of 50 patient scheduled appointments and managed patient flow while greeting visitors in a professional manner.
- Managed patients records and updated charts.
- Contacted pharmacies to submit and refill patients' prescriptions.
- Verified patient insurance.
- Collected specimen for lab testing.
- Demonstrated proficiency in monitoring patients vital signs.
Education
High School Diploma -
Cabrillo High School
Long Beach06-2009
Medical Assisting program - US
Wyotech
CASkills
- Customer service
- Time management
- Data entry
- Computer proficiency
- Microsoft Excel
- Scheduling
- CRM software
- Complaint handling
- Adaptability and flexibility
- HIPAA compliance
- Call center experience
- Patient confidentiality
- Insurance verification
- Patient eligibility verification
- Healthcare industry
Certification
- Certified by the The American Red Cross for Cardiopulmonary Resuscitation, Automated External Defibrillator/First Aid
- Venipuncture: Butterfly, Vacutainer, and Syringe Methods
Languages
Spanish
Intermediate
Timeline
Customer Service Representative
Molinahealthcare
12.2017 - 02.2026
Medical Assistant
Teresa Bondoc Md
10.2015 - 12.2017
Medical Assisting program - US
Wyotech
High School Diploma -
Cabrillo High School