Ligaya Lamoste
Rizal
Summary
Professional who excels in managing customer concerns and achieving resolution through effective communication and problem-solving. Background includes handling critical escalations and providing timely solutions that enhance customer satisfaction. Known for strong team collaboration and adaptability in dynamic environments, with expertise in conflict resolution and customer service.
Overview
8
8
years of professional experience
Work History
Escalation Specialist
Optum Global Solutions Inc.
03.2024 - 07.2025
- Resolved customer complaints by effectively managing escalations and addressing concerns in a timely manner.
- Developed customized action plans for each escalated case, ensuring tailored solutions that addressed clients'' unique needs.
- Coordinated with other departments to gather necessary information and resources for the successful resolution of escalated cases.
- Fostered strong relationships with clients by consistently demonstrating empathy, understanding, and dedication to resolving their concerns satisfactorily.
Senior Claims Specialist
Optum Global Solutions Inc
09.2020 - 03.2023
- Streamlined claims processing by implementing efficient workflow procedures and prioritizing high-impact cases.
- Managed a caseload of complex claims, ensuring timely settlements and maintaining client satisfaction.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Examined claims forms and other records to determine insurance coverage.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems.
Senior Customer Service Representative
Optum Global Solutions Inc.
02.2018 - 09.2020
- Resolved customer service issues using company processes and policies and provided updates to customers.
- Demonstrated excellent multitasking abilities by managing multiple concurrent tasks while ensuring timely completion.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Educated customers about billing, payment processing and support policies and procedures.
- Investigated and resolved customer inquiries and complaints quickly.
Customer Service Representative
Optum Global Solutions Inc.
10.2017 - 02.2018
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Reduced patient wait times while improving satisfaction levels through efficient problem resolution skills tailored to each unique situation.
- Stayed calm under pressure to and successfully dealt with difficult situations.
- Delivered exceptional support during high call volume periods by maintaining composure and professionalism under pressure.
- Promoted a positive work environment through active participation in team meetings and contributing ideas for organizational success.
Education
Bachelor of Arts - AB Mass Communication
New Era University
Diliman Quezon City04-1998
Skills
- Complaint investigation
- Excellent communication
- Customer service excellence
- Reporting and documentation
- Problem-solving skills
- Time management
- Attention to detail
- Multitasking Abilities
- Adaptability and flexibility
- Calm and professional under pressure
- Reliability
Timeline
Escalation Specialist
Optum Global Solutions Inc.
03.2024 - 07.2025
Senior Claims Specialist
Optum Global Solutions Inc
09.2020 - 03.2023
Senior Customer Service Representative
Optum Global Solutions Inc.
02.2018 - 09.2020
Customer Service Representative
Optum Global Solutions Inc.
10.2017 - 02.2018
Bachelor of Arts - AB Mass Communication
New Era University