Spencer Sevilla

• Provided client support for medical insurance inquiries, assisting with benefits verification, coverage information, claims status, eligibility, and policy-related questions while delivering accurate and timely resolutions. • Served as the primary point of contact for clients regarding medical insurance concerns, resolving inquiries related to coverage, claims, authorizations, and member benefits. • Reviewed authorization and referral requests to determine status and ensure timely processing. • Supported provider and member services by responding to inquiries and providing authorization updates. • Coordinated referral redirections to appropriate in-network providers based on member eligibility and service area. • Prepared and sent authorization and referral letters to providers and members via email and fax. • Verified member eligibility and benefits to support accurate authorization decisions. • Checked provider credentialing and contracting status to ensure network compliance. • Collaborated with internal teams and healthcare providers to resolve authorization and referral issues. • Maintained accurate documentation and ensured compliance with organizational policies and healthcare regulations. • Demonstrated strong attention to detail while managing multiple cases in a fast-paced healthcare environment • Delivered customer support for healthcare member services, assisting with eligibility and benefits verification, claims, authorizations, and provider-related inquiries. • Served as a Subject Matter Expert (SME), providing guidance and process support to team members on healthcare policies and procedures. • Conducted administrative training and onboarding sessions to improve employee knowledge, performance, and compliance. • Performed quality assurance evaluations by monitoring customer interactions, identifying improvement opportunities, and providing constructive feedback. • Assisted members with locating in-network providers and resolving healthcare coverage and benefit inquiries. • Maintained compliance with company policies, healthcare regulations, and quality standards while ensuring accurate documentation. • Applied strong product knowledge to resolve complex customer concerns and support first-call resolution. • Collaborated with cross-functional teams to enhance service quality, operational efficiency, and customer satisfaction.