michelle moquiala
Purok 5, Lower Nawanao Bayacabac, Maribojoc, Bohol,philippines
Summary
Detail-oriented Customer Service Representative with extensive experience in customer support and claims resolution. Proven skills in navigating healthcare policies while ensuring HIPAA compliance and managing high call volumes. Committed to leveraging CRM systems for effective case tracking and data integrity, driving improved customer satisfaction and operational efficiency through collaborative teamwork and proactive problem-solving.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Customer Service Representative
ibex
10.2024 - Current
- Resolved an average of 50+ member inquiries daily, ensuring accurate claims processing and improving customer satisfaction scores.
- Maintained 100% compliance with HIPAA regulations while assisting members with sensitive health information.
- Guided members through billing, eligibility, and enrollment procedures, simplifying complex healthcare policies into clear, actionable steps.
- Collaborated with cross-functional teams to escalate and resolve complex issues, improving turnaround time for claim resolutions.
- Utilized CRM systems and call center software to document interactions, track cases, and ensure data accuracy.
- De-escalated challenging situations, transforming negative experiences into positive outcomes for customers.
- Adapted quickly to policy updates and system changes, maintaining efficiency in a fast-paced environment.
- Managed high call volumes while maintaining quality service, consistently achieving performance metrics and service-level agreements.
Cashier
Local supermarket
04.2018 - 09.2024
- Processed high volumes of daily transactions with efficiency and precision to ensure seamless checkout experiences.
- Handled cash, card, and digital payments, ensuring accurate register balances and minimising discrepancies.
- Assisted customers with inquiries, returns, and product information to enhance shopping satisfaction.
- Maintained tidy and organised checkout areas to support store operations and customer contentment.
- Trained new staff and coordinated peak-hour operations, acknowledged for dependability and consistency.
- Reported low-stock items and assisted in replenishing shelves, supporting timely inventory management.
Skills
Skills
Healthcare knowledge
- Insurance policy knowledge
- HIPAA Compliance & Confidentiality
- CRM software expertise
Data Entry & Accuracy
- Technical organisation
- Customer Service & Communication
- Verbal and written skills
Active Listening & Empathy
- Conflict resolution
- Multitasking & Time Management
- Problem-solving skills
Team collaboration
- Policy adaptability
- Professional Strengths
- Policy adaptability
Languages
English
Upper Intermediate
B2
Certification
- Advocate of the Year – Q4 2025 (UnitedHealthcare)
- Recognized Top Employee – Jan to May 2026 (UnitedHealthcare)
Interests
- Reading – I enjoy immersing myself in books and often prefer quiet time with reading, as I am more of a book-oriented person
Watching Movies – One of my favorite pastimes, which I do regularly to relax and explore different genres and sto
Timeline
Customer Service Representative
ibex
10.2024 - Current
Cashier
Local supermarket
04.2018 - 09.2024