JONELYN ALMEDA
Customer Service Representative / Healthcare Virtual Assistant
Las piñas City
Summary
Experienced and client-focused Customer Service Representative with a strong background in the U.S. healthcare industry, offering over 2 years of experience in supporting members with insurance benefits, claims, billing, and provider services. Skilled in interpreting complex healthcare policies and resolving member concerns with accuracy and empathy. Proven ability to manage high call volumes while maintaining service quality and HIPAA compliance. Adept at using CRM systems and collaborating with cross-functional teams to ensure a seamless and personalized member experience. Committed to improving customer satisfaction and ensuring timely resolution of healthcare-related issues.
Overview
9
9
years of professional experience
5
5
Certifications
1
1
Language
Work History
Customer Service Representative
BGC
09.2023 - 06.2025
- Provide Benefits and Eligibility Information:
Clearly explain members' health plan coverage, benefits, copays, deductibles, and eligibility requirements. - Claims and Billing Support:
Assist members in understanding claim statuses, resolving billing issues, and interpreting Explanation of Benefits (EOBs). - Provider Search Assistance:
Help members locate in-network doctors, specialists, hospitals, and urgent care facilities based on their healthcare needs and plan. - Premium and Payment Assistance:
Guide members through making premium payments, setting up autopay, understanding grace periods, and resolving payment-related concerns. - Issue Resolution and Escalations:
Handle inquiries and complaints professionally, resolve problems efficiently, and escalate complex issues when needed to ensure timely resolution. - Customer Education:
Educate members on how to use their insurance, including how to access care, schedule appointments, and utilize member portals or mobile apps. - HIPAA Compliance and Confidentiality:
Maintain strict confidentiality of protected health information (PHI) in accordance with HIPAA regulations. - CRM and Documentation:
Accurately document all member interactions in CRM systems and maintain detailed records for follow-up and compliance. - Collaboration with Internal Departments:
Work with claims, enrollment, billing, and medical management teams to resolve member issues and improve the service experience. - Promote Preventive Care and Wellness Resources:
Inform members about available wellness programs, screenings, and preventive care options to encourage proactive health management.
HR Executive
Northgate Alabang
09.2017 - 04.2023
- Assisted applicants throughout the recruitment process, including initial outreach and preparation for their first interview.
- Conducted pre-screening interviews to assess qualifications, verify experience, and evaluate eligibility for open positions.
- Provided guidance and support during applicant examinations, ensuring a smooth and organized assessment process.
- Facilitated and participated in HR interviews for final candidate evaluations, focusing on cultural fit, communication skills, and role alignment.
- Prepared and extended job offers to successful candidates, including coordinating offer letters, compensation details, and onboarding timelines.
- Collected, reviewed, and verified employment requirements and documentation, ensuring completeness and accuracy for compliance.
- Performed various administrative HR tasks, such as maintaining candidate records, scheduling interviews, and updating tracking systems.
Customer Service Representative
Northgate Alabang
03.2016 - 07.2017
- Provided benefits and eligibility information to members, ensuring clear understanding of their healthcare plan coverage, copays, and deductibles.
- Assisted in reviewing claims and billing concerns, offering detailed explanations of charges, claim statuses, and resolving discrepancies efficiently.
- Helped members locate in-network providers, including doctors, specialists, and facilities, based on their plan and medical needs.
- Supported members with premium payments, including guidance on payment methods, due dates, troubleshooting issues, and maintaining continuous coverage.
Education
High school diploma -
SURIGAO PILOT SCHOOL
Surigao City, Province Of Surigao Del Norte, Philippines 04.2001 - 01.1996
Skills
Specialized in managing member services within the US healthcare system, with in-depth knowledge of insurance plans, including [insert niche, eg, Medicare Advantage, Medicaid, ACA Marketplace plans, or Commercial PPO/HMO plans]
Certification
CSR - US healthcare, Hinduja Global Solutions, 07/01/24
Personal Information
- Date of Birth: 06/22/79
- Nationality: Filipino
- Marital Status: Single
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Accomplishments
Professional Summary:
Highly skilled Advanced Customer Service Representative with over 2 years of experience in the U.S. healthcare industry and 5 years in HR support, providing top-tier service in fast-paced, compliance-driven environments. Known for exceptional communication, deep knowledge of healthcare policies, and a proactive approach to resolving member and employee concerns. Experienced in managing complex inquiries, supporting escalations, and contributing to process improvements. Adept at using CRM and HRIS systems, ensuring a seamless experience for stakeholders while maintaining strict HIPAA and organizational confidentiality standards.
Key Responsibilities:Delivered advanced support to members regarding healthcare benefits, eligibility, claims, billing, and provider navigation
- Handled escalated issues and complex service concerns with professionalism, accuracy, and empathy.
- Interpreted and explained health insurance policies, including Medicare/Medicaid, ACA plans, and commercial coverage.
- Utilized CRM systems (e.g., Salesforce, Zendesk) to track, manage, and follow up on cases.
- Ensured strict HIPAA compliance and safeguarded sensitive member information.
- Collaborated with internal departments to resolve service delays, claim disputes, and enrollment issues.
- Supported HR operations by assisting with interviews, onboarding, documentation, and administrative tasks.
- Trained and mentored new customer service team members to improve service quality and knowledge retention.
Timeline
Customer Service Representative
BGC
09.2023 - 06.2025
HR Executive
Northgate Alabang
09.2017 - 04.2023
Customer Service Representative
Northgate Alabang
03.2016 - 07.2017
High school diploma -
SURIGAO PILOT SCHOOL
04.2001 - 01.1996
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