JULIAN ESTEBAN GARZON BERNAL
Bogotá,Colombia
Summary
Bilingual Healthcare Operations Professional experienced in supporting U.S. health plans with claims, benefits, and coverage administration for international companies. Achieved high-quality outcomes through expertise in healthcare coverage review, claims processing, and provider network verification. Focused on delivering immediate value in Healthcare Operations, Claims Support, or Revenue Integrity through strong analytical skills and attention to detail.
Overview
5
5
years of professional experience
Work History
Service Coordinator - Healthcare Operations
Concentrix | Cigna Healthcare
05.2024 - Current
- Manage 10-12 daily cases involving member eligibility, benefits termination and inquiries, enrollment processing, and COBRA administration for the U.S. market.
- Verify doctor and provider network coverage, answering member questions on plan benefits, coverage limits, and cost-sharing details.
- Process and validate prior authorization requests, confirming coverage, medical necessity documentation, and provider network status.
- Reviewed and supported claims-related inquiries, including balance billing issues, coordinating with providers and internal teams to resolve discrepancies, enhancing member satisfaction.
- Tracked complex cases end-to-end, ensuring compliance with Service Level Agreement (SLA) targets to maintain operational efficiency.
- Research and apply CPT and HCPCS procedure codes to validate claims accuracy and support correct service coordination and reimbursement.
- Maintain medical documentation and member records with a strong focus on accuracy and confidentiality.
- Met Quality Assurance (QA) and productivity metrics consistently, contributing to team success and earning monthly performance bonuses.
- Work daily with Salesforce, Facets, Fiserv, Citrix, OneView, ServiceNow, CED, Excel, and Outlook.
Customer Support Representative - OneTouch
Sitel Group
03.2022 - 10.2022
- Delivered specialized support to patients with OneTouch glucose monitoring devices, facilitating setup and ensuring correct usage.
- Diagnosed device-related and user-procedure issues, resolving technical inquiries with clarity and empathy.
- Resolved issues by analyzing customer concerns and providing solutions.
- Assisted customers with inquiries through phone and chat channels.
- Documented customer interactions in the support ticketing system accurately.
Logistics Support - Walmart Account
Teleperformance
10.2021 - 02.2022
- Coordinated delivery and order processes to ensure accuracy of shipped products.
- Managed warranty and delivery requests, resolving logistics issues to enhance response time and customer satisfaction.
- Oversaw daily tasks to ensure smooth operations. to maintain efficiency and organization. accurately and efficiently.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
Marketplace & E-commerce Seller
- Coordinated online sales, optimizing product listings, handling customer service, negotiating pricing, managing shipping, overseeing inventory, and conducting post-sale follow-up.
- Guided customers in selecting suitable products based on their needs.
- Processed transactions accurately using point-of-sale systems.
- Arranged product displays in an appealing manner to attract customers.
Education
High School Diploma -
Instituto Andino
Bogotá, ColombiaSkills
- Salesforce
- Facets
- Fiserv
- ServiceNow
- Microsoft Excel
- Microsoft Outlook
- Claims support
- Billing Discrepancy Resolution
- Prior Authorizations
- Benefit Verification
- Provider Network Management
- Member Enrollment Support
- COBRA
- Eligibility checks
- Attention to Detail
- Time Management
- Written Communication
- Problem Solving
- Claims processing
- Medical coding
- Salesforce utilization
- Customer relationship management
- Medical terminology
- Confidentiality practices
- Eligibility verification
- Data analysis
- Attention to detail
- Problem resolution
Languages
- Spanish, Native
- English, B2+
Timeline
Service Coordinator - Healthcare Operations
Concentrix | Cigna Healthcare
05.2024 - Current
Customer Support Representative - OneTouch
Sitel Group
03.2022 - 10.2022
Logistics Support - Walmart Account
Teleperformance
10.2021 - 02.2022
Marketplace & E-commerce Seller
High School Diploma -
Instituto Andino