Dora Cruz












Dora Cruz


5115 N Socrum Loop Rd, Lakeland, Fl 33809


felidora05@gmail.com 203-572-2860



 



Profile


Award Winning Customer Service Leader and benefits coordinator, experienced in high-volume call center environments, as well as small firms. Committed to and recognized for delivering quality customer service for external/internal stakeholders with the ability to resolve complex issues, build productive relationships with management and staff.  A self-confident successful team player with vision who stays close to the action with excellent communication, decision making and problem solving skills.


 


                                                       WellDyne/ Eagle Pharmacy


       Lakeland, FL                                                        2016


Industry leader of health and wellness solutions tailored for health care providers, leaders, organizations and pharmacies.


Receive in bound calls from patients requesting refills


Place and process orders for patients using Epost Rx.


Make outbound calls to enroll new members and refill reminders.


Inquire and verify on health insurance from patients.


Proficiency in Microsoft suites.


Maintain communication with pharmacist to override error codes.


Verify and update patient demographics.


                         Jewish Home for the Aged                                                                 Fairfield, CT                                                   2010-2011


Jewish Senior Services has been a leader and trusted provider for skilled nursing and senior care or over 40 years.


 


Provides for activities of daily living by assisting with serving meals, feeding patients as necessary; ambulating, turning, and positioning patients; providing fresh water and nourishment between meals.


Maintains patient stability by checking vital signs and weight; testing urine; recording intake and output information.


Provides patient comfort by utilizing resources and materials; transporting patients; answering patients' call lights and requests; reporting observations of the patient to nursing supervisor.


Documents actions by completing forms, reports, logs, and records.


Maintains work operations by following policies and procedures.


Protects organization's value by keeping patient information confidential.


Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state, and local requirements, and jcaho standards.


                                        HEALTHNET of the NORTHEAST                                     


   Shelton, CT                                                          2007-2010  


Health Net, Inc. is one of the largest publicly traded managed health care companies in the United States. They provide health benefits to approximately 6.6 million individuals in all 50 states and the District of Columbia.


 


Customer Service Representative/Claims Processor


Successfully researched and resolved complex client escalations (brokers and employers) with focus on providing a “win-win” solution and contributing to customer retention.


Created/implemented and maintained daily Internet production report along with weekly/monthly compliance reports.


Maintained a thorough working knowledge of company products and procedures.


Actively participated in team meetings.


Selected by management to train and mentor new hires.


Processed claims and claim adjustments.


                                                                                                                                                                                 Professional Training


 


HIPPA Regulations, Code of Business Conduct and Ethics, Getting the Records Straight, General and Medicare Compliance, and Healthcare and RX Fraud, In-network/out-of network processional claims.


 


Technical Skills


 


Microsoft Word, EPost RX, Excel, Lotus Notes, MC400, Macess, Salsa, DXR, MS Outlook, CRM, E-benefits, HR360, Employee Navigator, HR Connection, Various carrier benefit portals


 

  • ID#: 115581
  • Location: Lakeland, FL , 33810

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