Jessica Gatica

Dedicated and customer-focused Customer Care Representative with almost four years of experience in the healthcare industry at Carelon Global Solutions. Skilled in HIPAA verification, eligibility and benefits, authorization checking, Medicare appeals and grievances, claims processing, provider and member services, and chat support. Seeking to utilize my strong communication, problem-solving, and customer service skills to contribute to a dynamic organization while continuously growing professionally and delivering excellent customer experience.

Customer Care Representative - Carelon Global Solution

(2022-10 - 2026-06)

Provided exceptional customer service support for healthcare members and providers through inbound calls and chat support while ensuring compliance with company policies and HIPAA regulations.

• Performed HIPAA verification to validate member and provider information before discussing protected health information (PHI).
• Assisted members and providers with eligibility and benefits inquiries, coverage verification, claims status, and policy information.
• Handled authorization and requirement checking for medical services, referrals, and treatment approvals.
• Managed Medicare appeals and grievances by documenting concerns accurately and ensuring proper escalation and resolution processes.
• Supported claims processing concerns, including claim status, denials, corrections, and payment-related inquiries.
• Transitioned from Provider Services to Member Services in January 2023 and later reassigned back to Provider Services under another line of business (LOB), demonstrating flexibility and adaptability in handling multiple healthcare accounts.
• Cross-trained and skilled in chat support, providing professional written communication and efficient issue resolution for customers.
• Maintained high standards of accuracy, confidentiality, and professionalism while handling sensitive healthcare information.
• Collaborated with internal teams and departments to resolve complex cases and improve customer experience.
• Demonstrated strong multitasking, communication, and problem-solving skills in a fast-paced healthcare environment.

Sales Account Executive - Schalen Sales Corporation

(2019-07 - 2022-08)

Results-driven and people-oriented professional with solid experience in sales and executive-level responsibilities with strong skills in communication, negotiation, and relationship building.

• Handled client acquisition, customer retention, and product promotion, ensuring that clients understand the value of what we offer and feel confident and satisfied with their decisions.
• Consistently met targets and contributed to business growth.
• Highly adaptable and effectively worked in fast-paced environments while maintaining a positive and professional approach.

Bachelor of Science - Hotel and Restaurant - ILOILO SCIENCE AND TECHNOLOGY UNIVERSITY (2018)