Ramon Roa
Summary
Experienced Customer Service Specialist with a strong background supporting members and providers in the healthcare insurance industry. Skilled in handling eligibility, benefits, claims, authorizations, and wellness program inquiries for major insurers, including UnitedHealthcare, Anthem, Aetna, Cigna, Humana, and others.
Proficient in assisting members with Healthy Benefits+ programs, OTC orders, and account management while maintaining HIPAA compliance and delivering excellent customer service across multiple channels.
Tools: Salesforce CRM, Oracle CRM, Zendesk, Avaya, Cisco Finesse, Genesys Cloud, NICE platforms, Epic Systems, HealthSafe ID, Healthy Benefits+ Portal, Microsoft Teams, ServiceNow.
Overview
4
4
years of professional experience
Work History
Medical Billing Specialist
concentrix
01.2022 - 05.2023
- Provided assistance to Medicare and commercial insurance members.
- Tools used: Genesys Cloud, Avaya, Humana case management applications.
- Handled pre-certifications and reimbursement requests.
UnitedHealthcare
concentrix
01.2020 - 06.2021
- Assisted members with eligibility, benefits, claims, and authorizations.
- Tools used: Salesforce CRM, Avaya Call Center, One Healthcare ID Portal.
- Managed confidential information in strict HIPAA compliance.
Healthy Benefits+
concentrix
01.2019 - 12.2019
- Assisted members in accessing and managing their Healthy Benefits+ accounts to purchase eligible products and apply discounts.
- Provided support with balance inquiries, OTC (over-the-counter) product orders, and troubleshooting online platform issues.
- Educated members on program eligibility and benefit usage guidelines.
- Tools used: Salesforce CRM, Healthy Benefits+ proprietary portal, Avaya Call Center, Genesys Cloud, Microsoft Teams.
- Maintained strict adherence to HIPAA and data privacy regulations.
Education
Universidad utesa
07.2025
Educación Técnico/Profesional
infotep
07.2025
Skills
- CRM Systems:
Salesforce CRM
Salesforce Service Cloud
Oracle CRM
HealthSafe ID Portal - Contact Center Software:
Avaya Call Center
Cisco Finesse
Genesys Cloud
NICE InContact
NICE CXone - Member Portals and Platforms:
Healthy Benefits Portal
One Healthcare ID
My Health Manager (Kaiser Permanente)
Epic Systems
- Collaboration & Communication:
Microsoft Teams
Zoom
Slack - Knowledge Bases & Ticketing:
Zendesk
ServiceNow - Other Tools:
Centene proprietary platforms
Molina internal systems
Humana case management tools
Languages
Español - Nativo, Inglés - Avanzado, Italiano - Intermedio
Languages
Spanish
First Language
English
Proficient (C2)
C2
Italian
Intermediate (B1)
B1
Desplazamiento y movilidad Commuting and mobility
- Disponibilidad para viajar
- Disponibilidad para cambiar de residencia
- No tengo vehículo propio
¿Qué trabajo buscas? What job are you looking for?
- Medicine / Healthcare
Timeline
Medical Billing Specialist
concentrix
01.2022 - 05.2023
UnitedHealthcare
concentrix
01.2020 - 06.2021
Healthy Benefits+
concentrix
01.2019 - 12.2019
Universidad utesa
Educación Técnico/Profesional
infotep
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