JUDELINE PLATA
HEALTHCARE INSURANCE REPRESENTATIVE
Baguio City, Province Of Benguet
Summary
Knowledgeable healthcare insurance representative with 10 years of experience, ensuring outstanding resolution and customer satisfaction. Adept in understanding medical terminology and insurance guidelines. Skilled in problem solving and multi tasking in fast-paced environments, consistently recognized for exceptional service and commitment to patient care.
Overview
11
11
years of professional experience
Work History
Flex Trainer for Claim Specialist
Alorica
05.2015 - 02.2018
- Assessed the effectiveness of training initiatives by tracking participant progress and collecting feedback for continuous improvement.
- Offered personalized mentoring to support individuals reach their full potential within the organization.
- Worked together with subject matter experts to develop accurate training content.
- Mentored employees on best practices, offering constructive feedback to support their professional growth.
- Fostered a culture of continuous improvement by implementing regular training feedback cycles.
- Trained and mentored newly hired employees.
- Carried out detailed investigations into insurance information to determine fair claim payment.
- Familiarized with claim denials, which helped improve the overall efficiency and success rate of claims handling.
Healthcare Customer Service Representative
Alorica
12.2013 - 02.2018
- Answered incoming phone calls with duties of providing accurate information regarding their benefits, eligibility, claims and verifying if pre-certification or predetermination was required.
- Assisted customers with claim submissions and clarified denial reasons.
- Managed confidential customer information with discretion, ensuring compliance with strict data privacy regulations at all times.
- Attended in all on going sessions to stay updated on industry developments and enhance overall job performance.
- Handled high-volume call queues efficiently, ensuring minimal wait times for customer inquiries.
- Responded swiftly to customer complaints, effectively reducing escalation rates.
- Did extra miles for unresolved issues to increase customer satisfaction rates.
- Applied professional and personal skills to exceed customer satisfaction.
- Addressed issues with empathy by listening attentively, understanding, and showing care, ensuring the customer felt heard and supported throughout the process.
Fax Triager Utilization Management
EXL Service
05.2023 - 12.2024
- Promptly tracked and retrieved incoming faxes.
- Organized and prioritized faxes according to urgency, content, or intended recipient.
- Directed faxes to the appropriate individual or department.
- Informed appropriate personnel about urgent or critical document.
- Input correct information from faxes into internal system.
- Ensured the accuracy and completeness of received fax document.
- Resolved issues with incomplete, illegible, or misrouted faxes.
- Contacted senders regarding missing or unclear information needed.
- Managed sensitive documents in accordance with HIPAA regulations.
- Guaranteed the secure transmission of confidential information.
- Assisted other team members with clerical task, ensuring documents are processed without errors.
- Troubleshooted technical issues and resolving associated problems.
Healthcare Customer Service Representative
EXL Service
02.2018 - 04.2023
- Maintained a high level of product knowledge, ensuring the delivery of accurate information to customers.
- Developed strong relationships with clients through attentive listening and empathetic understanding of their needs.
- Addressed customer complaints with professionalism, leading to satisfactory resolutions and positive feedback.
- Actively listened to customer, investigated issues, and resolved customer inquiries and complaints quickly.
- Helped the customer gladly and genuinely, ensuring a positive outcome resulting to customer loyalty.
- Safeguarded HIPAA (Health Insurance Portability and Accountability Act) to maintain patient trust and avoid legal repercussion.
Education
Bachelor of Science - Nursing
Pines City Colleges
Baguio City, Province Of Benguet, Philippines 04.2001 -
Skills
Resourcefulness and initiative
HIPAA compliance
Medical terminology proficiency
Professionalism and ethics
Insurance verification
Interpersonal and written communication
Outpatient care
Medical coding
Utilization management
Communication
Teamwork and collaboration
Ability to analyze and resolve issues effectively
Singing praise and worship songs
I love singing praise and worship songs as this is one way for me to worship, praise, express my joy, and approach God with thanksgiving.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Accomplishments
- Achieved high quality assessment's completing prioritization with accuracy and efficiency.
- Supervised team of 3 agents.
- Effectively trained and supported both trainees and experienced agents.
Timeline
Fax Triager Utilization Management
EXL Service
05.2023 - 12.2024
Healthcare Customer Service Representative
EXL Service
02.2018 - 04.2023
Flex Trainer for Claim Specialist
Alorica
05.2015 - 02.2018
Healthcare Customer Service Representative
Alorica
12.2013 - 02.2018
Bachelor of Science - Nursing
Pines City Colleges
04.2001 -