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Jelofe O. — Mid-Level Healthcare Customer Service Specialist from Philippines

Jelofe O.

Mid-Level Healthcare Customer Service Specialist

Philippines No experience yet
Open to offersNew to Platform
Languages
EnglishTagalog
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About

Jelofe Y. is a conscientious and patient-focused Customer Service Representative with over three years of experience supporting US-based healthcare accounts. Excelling in managing high-volume patient and provider inquiries, she specializes in insurance verification, claims assistance, benefits/eligibility issues, Coordination of Benefits, and enrollment management. At Optum Global Solutions, Jelofe handled 30–40 patient/provider calls daily, maintaining a 95% accuracy in eligibility verification while safeguarding sensitive patient data compliant with HIPAA. Her problem-solving skills led to a 75% reduction in issue resolution turnaround time by collaborating with providers and insurers. At Alorica, she managed Medicare Part D inquiries and appeals, enhancing patient satisfaction and minimizing repeat calls. Recognized for exceeding quality benchmarks and ensuring CMS compliance, Jelofe also provides empathetic support, improving operational efficiency across fast-paced healthcare environments. She holds certificates in HIPAA, fraud and abuse prevention, and Medicare & Retirement training.

Experience

  • Customer Service Representative

    Alorica (Wellcare Prescription) · 2024 — 2026
    Handled a high volume of inquiries related to Medicare Part D, providing information on coverage, benefits, and claims. Ensured compliance with CMS guidelines while delivering accurate eligibility and formulary details. Supported patients through the appeals process, offering comprehensive case updates. Addressed coverage overlaps with Medicare and insurers to safeguard correct billing. Delivered empathetic support to enhance patient satisfaction and managed enrollment and disenrollment requests accurately. Surpassed performance metrics for call quality and compliance audits, maintained detailed documentation for efficient follow-up.
  • Customer Service Representative

    Optum Global Solutions (United Healthcare)
    Managed 30–40 patient and provider inquiries daily, addressing topics such as insurance, claims, and billing. Assisted patients with eligibility verifications and benefits explanations, maintaining high accuracy. Ensured HIPAA compliance while handling sensitive patient information across various communication channels. Collaborated with providers and insurers to resolve complex issues effectively, significantly decreasing turnaround times. Processed payment inquiries and coordinated billing through various methods, delivered clear patient guidance, and updated pre-authorization statuses. Communicated updates regarding appeals for medical services and managed Medicare coordination accurately. Handled enrollment and disenrollment processes for Medicare Advantage, facilitated referrals, and arranged timely appointments.

Skills & Expertise

Education

  • Bachelor of Elementary Education (BEED)
    University of Mindanao
  • High School Graduate
    Panabo National High School
  • Elementary Graduate
    Limbaan Elementary School