Jay Adiova

Customer Service Representative with years of experience supporting healthcare, dental, and medical insurance providers and members. Skilled in benefits administration, eligibility verification, coverage explanation, claims resolution, and provider coordination. Experienced in guiding members through complex health plans, including deductibles, co-pays, out-of-pocket maximums, and covered services.

Proven ability to interpret insurance policies, resolve billing and claims concerns, ensure HIPAA compliance, and deliver compassionate customer support while maintaining accuracy in fast-paced environments. Strong background in handling high-volume inquiries, documenting member interactions, and helping customers maximize their healthcare benefits.

Customer Service Representative I at Concentrix Philippines (2023-09 – 2025-04)

• Assisted providers and members with benefit inquiries by explaining coverage, eligibility, deductibles, co-pays, co-insurance, and out-of-pocket maximums.
• Verified member eligibility and benefits for medical and dental services, ensuring accurate information was provided to members and providers.
• Investigated and resolved complex claims, billing, and coverage issues while maintaining compliance with company policies and HIPAA regulations.
• Guided members through healthcare plans and insurance portals, helping them understand covered services and benefit limitations.
• Coordinated with healthcare providers regarding benefit verification, claim status, and coverage-related concerns to ensure timely resolution.
• Documented customer interactions, benefit inquiries, and case resolutions accurately within the CRM system to maintain detailed records and continuity of service.
• Managed a high volume of inbound calls while consistently meeting quality, productivity, and customer satisfaction standards.

Customer Service Representative I at Concentrix Philippines (2022-10 – 2023-03)

• Helped elderly customers use their insurance benefits to order groceries, health items, and pay bills over the phone.
• Provided patient and friendly assistance to answer questions, check account balances, and explain available benefits.
• Tracked shipments to make sure customers received their items on time and helped resolve any delivery issues.
• Accurately recorded all call details, account updates, and order information in the computer system.

Bachelor of Secondary Education in Major in Filipino – Baao Community College (2021-08 – 2026-06)