Summary
Overview
Work History
Education
Skills
Certification
Languages
Interests
Timeline
Teacher
ROLY JR. LEYSA E.

ROLY JR. LEYSA E.

Educator
Lambunao

Summary

A highly motivated and academically accomplished professional, graduating with Latin honors "Cum Laude" and a proven track record in the BPO healthcare sector. Currently supporting a U.S.-based healthcare account, where I’ve demonstrated excellence in customer interaction, process knowledge, and compliance standards. Awarded as "Nesting Champion during the training phase. Further recognized through formal "customer commendation", affirming my commitment to quality service, empathy, and professionalism. Seeking to leverage these strengths in a challenging, growth-driven environment where I can contribute value, expand my capabilities, and build a meaningful career.

Overview

3
3
years of professional experience
1
1
Certification

Work History

Customer Care Representative

Carelon Global Solutions
07.2024 - Current
  • Healthcare BPO Customer Care Represent| Carelon Global Solutions Philippines
  • Highly motivated BPO professional with hands-on experience in U.S. healthcare account support, known for top-tier performance during nesting and post-production phases. Commended by clients for service excellence, empathy, and communication skills. Proven ability to resolve complex healthcare concerns valued members.
  • KEY SKILLS & COMPETENCIES
  • - U.S. Healthcare Process Knowledge (Claims, Eligibility, Benefits, Billing, Reinstatement of the Policy, Grievance and Appeals)
  • - Member Support
  • - Call Quality Management (QA standards, AHT, CSAT)
  • - HIPAA & Data Privacy Compliance
  • - Tools: NICE, MS Office Suite, Solution Central, Mainframe, ACA Provider Network Guide Excel File
  • - Conflict Resolution & Empathetic Communication
  • - Coaching and Peer Mentorship during Nesting
  • - Performance under Pressure / Time Management
  • PROFESSIONAL EXPERIENCE
  • - Providing high-quality support to U.S. healthcare members addressing inquiries related to eligibility, claims status, benefit coverage, reinstatement of the policy, billing inquiry, filing grievance and appeals.
  • - Achieved "Nesting Champion" recognition for top performance in call handling, accuracy, and call quality during onboarding phase.
  • - Received direct "customer commendation" for exceptional service, highlighting empathy, professionalism, and product knowledge.
  • - Consistently met or exceeded key metrics such as CSAT, AHT, QA scores, and schedule adherence.
  • - Collaborated with team leads and trainers to widen knowledge and skills in terms of product and process.

Inbound Customer Service Representative

SAGILITY
10.2022 - 05.2024
  • Results-driven Customer Service Representative with over 1 year and 7 months of experience handling U.S.-based healthcare accounts in a high-volume BPO environment. Adept at resolving complex member inquiries, interpreting insurance benefits, and supporting healthcare providers with accuracy and empathy. Recognized for strong communication skills, compliance with HIPAA standards, and contributing to high customer satisfaction scores.
  • CORE SKILLS
  • - Healthcare Insurance Knowledge (HMO, PPO, EPO, POS plans)
  • - Claims Processing & Benefits Verification
  • - Provider Support
  • - HIPAA Compliance
  • - CRM & Call Handling Systems (e.g., Avaya, Salesforce, NICE)
  • - Conflict Resolution & Empathy
  • - Call Quality & AHT Management
  • - Team Collaboration & Reporting
  • PROFESSIONAL EXPERIENCE
  • - Assisted an average of 20-40 providers daily with inquiries regarding eligibility, benefits, claims status, and authorizations.
  • - Navigated through multiple systems to provide accurate, real-time information while maintaining compliance with HIPAA guidelines.
  • - Consistently achieved call quality scores of 95% and exceeded KPIs related to AHT and customer satisfaction (CSAT).

Teaching Internship

Caninguan Central School
01.2022 - 03.2022
  • Aspiring Educator | Pre-Service Teaching Experience
  • PROFESSIONAL SUMMARY
  • Enthusiastic and detail-oriented pre-service teacher with hands-on experience delivering engaging and developmentally appropriate instruction during practicum at Caninguan Central School. Demonstrated commitment to student growth, classroom management, and collaborative teaching. Adept at lesson planning, instructional delivery, and formative assessment, with strong communication and adaptability in a diverse learning environment.
  • TEACHING EXPERIENCE
  • Caninguan Central School
  • Pre-Service Teacher (Internship)
  • January – March 2022 | Lambunao, Iloilo Philippines
  • - Delivered lessons from 1st Grade to 3rd Grade level, subjects are Math, English, Filipino, Science, etc., using learner-centered methods aligned with DepEd curriculum standards.
  • - Designed and implemented engaging instructional materials to promote active student participation.
  • - Assisted in managing classroom behavior and fostering a respectful, inclusive learning environment.
  • - Conducted formative assessments and provided feedback to support student progress.
  • - Collaborated with the cooperating teacher and school staff during lesson planning, school events, and teaching observations.
  • - Gained valuable exposure to real-world teaching dynamics, student needs, and effective pedagogical techniques.
  • KEY SKILLS
  • - Lesson Planning & Curriculum Development
  • - Classroom Management
  • - Student Engagement & Communication
  • - Instructional Materials Design
  • - Assessment & Feedback
  • - Collaboration & Reflective Practice

Education

Bachelor of Elementary Education -

West Visayas State University
Lambunao, Iloilo
07-2022

Skills

  • Digital/ICT Literacy
  • Adaptability
  • Willingness to Improve
  • Quality Customer Service
  • Independent and Goal Driven
  • Empathy
  • Listener
  • Communication Skills
  • Comprehension Skills
  • English and Filipino fluency
  • Multitasking
  • Attention to detail
  • Time management
  • Problem-solving
  • Teamwork and collaboration
  • Professional phone voice
  • Call handling
  • Providing customer support
  • Inbound phone call management
  • Payment processing
  • Training experience
  • Interpersonal skills
  • Verbal and written communication
  • Language proficiency
  • Documentation and reporting

Certification

  • Licensed Professional Teacher since 2023
  • Nesting Champion, CARE 2.0 score of 100%, IR score of 100% and reliability of 100%. Carelon Global Solutions - November 1st, 2024.
  • Certified Customer Service Representative, at Sagility in 2022-2024 Customer Care Representative at Carelon Global Solutions in 2024 to present.


Languages

English
Professional Working

Interests

  • Dancing
  • I enjoy helping others and giving back to the community
  • Exploring famous landmarks, historical sites, and cultural attractions in a new destination
  • Participating in cultural exchange programs and homestays
  • Documenting and sharing travel experiences
  • Getting involved in local advocacy groups to promote positive change in the community
  • Graphic Design
  • Reading
  • Music
  • Engaging in food photography and sharing culinary creations on social media
  • I have a passion for photography and editing photos
  • Fashion and Style
  • Environmental Conservation Projects
  • Photography
  • Personal Development and Self-Improvement

Timeline

Customer Care Representative

Carelon Global Solutions
07.2024 - Current

Inbound Customer Service Representative

SAGILITY
10.2022 - 05.2024

Teaching Internship

Caninguan Central School
01.2022 - 03.2022

Bachelor of Elementary Education -

West Visayas State University

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