Carroll Reyes
Columbus
Summary
Customer Care Representative with 6+ years of experience at Elevance Health providing exceptional service to health plan members and providers. Skilled in resolving complex benefit and claims inquiries, researching issues, documenting interactions accurately, and achieving first-call resolution while maintaining HIPAA compliance. Recognized for empathy, problem-solving, and delivering high-quality customer experiences in a fast-paced call center.
Overview
13
13
years of professional experience
Work History
Customer Care Representative II
Anthem/Elevance Health
Remote
10.2019 - 01.2026
- Assisted customers with health plan benefits, eligibility, claims, billing, and authorization inquiries.
- Researched and resolved complex customer issues while meeting quality and productivity standards.
- Documented all customer interactions accurately in company systems.
- Achieved high first-call resolution through effective problem-solving and active listening.
- Protected confidential member information in compliance with HIPAA regulations.
- Collaborated with internal departments to resolve escalated issues promptly.
- Consistently delivered compassionate, professional customer service in a high-volume call center environment.
- Maintained up-to-date knowledge of healthcare regulations and industry changes.
Customer Service Representative/Coach
Concentrix
Remote
11.2017 - 10.2019
- Resolved customer inquiries and complaints via phone, email, and chat.
- Provided accurate product information and troubleshooting guidance to enhance customer satisfaction.
- Trained new staff on company policies and effective customer interaction techniques.
- Graded calls for quality assurance to uphold service standards.
- Analyzed customer data to identify trends and recommend operational improvements
Lead Cashier
Shell Gas Station
Cataula
07.2013 - 11.2017
- Implemented process improvements that enhanced the efficiency of cash handling procedures.
- Supervised daily cash operations and ensured compliance with company policies.
- Resolved customer inquiries and complaints promptly, improving overall satisfaction ratings.
- Conducted audits of cash registers to maintain accuracy in financial reporting.
Skills
- Customer service
- Claims processing
- Health insurance expertise
- HIPAA compliance
- Complaint resolution
- First call resolution
- Quality assurance
- Insurance Verification
- Appointment Scheduling
- Call center experience
- CRM systems
- Call Documentation
- Customer data analysis
- Critical thinking and analysis
- Problem Solving
- Active listening
- Coaching techniques
- Multitasking
- Data entry
- Microsoft office 365
- Medical terminology
- Relationship management
- Patient confidentiality
Timeline
Customer Care Representative II
Anthem/Elevance Health
10.2019 - 01.2026
Customer Service Representative/Coach
Concentrix
11.2017 - 10.2019
Lead Cashier
Shell Gas Station
07.2013 - 11.2017