Career Profile
KELAR RIVERA
PROFILE
Motivated, results-focused customer service professional with experience in both retail and healthcare industries, and an educational background in Fashion Merchandising. Now seeking a challenging opportunity as a retail merchandiser with a forward-thinking company to leverage merchandising knowledge for professional and personal growth.
Previous retail experience includes setting sales floor plan-o-grams, facilitating merchandise flow, performing promotional ad setup, maintaining visual merchandising standards and guest services for major retailers including Target, Trade Secret and Sears. Presently serves as a volunteer Image and Career Development Coach with Dress For Success Atlanta.
CONTACT
PHONE:
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ADDRESS:
7350 Campbellton Rd. Apt. 909
Atlanta, GA 30331
EMAIL:
K------------
HOBBIES
Fashion & Style Research
Natural Hair Care & Styling
Drawing/Sketching
EDUCATION
Wayne State University
2001 – 2011
BA Fashion Merchandising
Course Work: Intro to Merchandising, Merchandising II, Textiles I, Visual Merchandising, Retail Management
WORK EXPERIENCE
Robert Half International Inc Customer Care Professional/Optum 360
Sandy Springs, GA December 2018–March 2019
Handled member and provider inquiries regarding plan benefits, referrals, and prior authorizations via inbound phone calls. Calm irate callers, repair trust, locate resources for problem resolution. Interface daily with internal department agents, team leads, and supervisors. Commended for intense member focus and outstanding service.
Meridian Health Plan Claims Examiner-Claims Appeals Coordinator
Detroit, MI July 2015–June 2018
Processed inbound department calls provided status of claims and claims appeals, responded to inquiries, resolved issues, corrected processing errors. Managed an average of 400 appeals submissions monthly, processed at least 200 claims daily. Implemented claims process improvements to decrease fraud, waste and abuse, saving the company time and money. Co-created and updated department job aides to ensure consistence and accuracy of claims and claims appeals processing.
Henry Ford Health System Contact Center Advocate I
Detroit, MI August 2010–July 2015
Responded to telephone inquiries, provided quality service to callers while assisting with appointment scheduling, registration, profile updates, prescription requests, and placing in contact with clinical staff. Successfully led new advocate training for 11 employees. Achieved quality score of 96% within six months, exceeding contact center target.
SKILLS
• Creative Problem Solving
• Clear Verbal and Written Communication
• Retail and Customer Service
• Project Management
• Interpersonal Skills
KELAR RIVERA
PROFILE
Motivated, results-focused customer service professional with experience in both retail and healthcare industries, and an educational background in Fashion Merchandising. Now seeking a challenging opportunity as a retail merchandiser with a forward-thinking company to leverage merchandising knowledge for professional and personal growth.
Previous retail experience includes setting sales floor plan-o-grams, facilitating merchandise flow, performing promotional ad setup, maintaining visual merchandising standards and guest services for major retailers including Target, Trade Secret and Sears. Presently serves as a volunteer Image and Career Development Coach with Dress For Success Atlanta.
CONTACT
PHONE:
------------
ADDRESS:
7350 Campbellton Rd. Apt. 909
Atlanta, GA 30331
EMAIL:
K------------
HOBBIES
Fashion & Style Research
Natural Hair Care & Styling
Drawing/Sketching
EDUCATION
Wayne State University
2001 – 2011
BA Fashion Merchandising
Course Work: Intro to Merchandising, Merchandising II, Textiles I, Visual Merchandising, Retail Management
WORK EXPERIENCE
Robert Half International Inc Customer Care Professional/Optum 360
Sandy Springs, GA December 2018–March 2019
Handled member and provider inquiries regarding plan benefits, referrals, and prior authorizations via inbound phone calls. Calm irate callers, repair trust, locate resources for problem resolution. Interface daily with internal department agents, team leads, and supervisors. Commended for intense member focus and outstanding service.
Meridian Health Plan Claims Examiner-Claims Appeals Coordinator
Detroit, MI July 2015–June 2018
Processed inbound department calls provided status of claims and claims appeals, responded to inquiries, resolved issues, corrected processing errors. Managed an average of 400 appeals submissions monthly, processed at least 200 claims daily. Implemented claims process improvements to decrease fraud, waste and abuse, saving the company time and money. Co-created and updated department job aides to ensure consistence and accuracy of claims and claims appeals processing.
Henry Ford Health System Contact Center Advocate I
Detroit, MI August 2010–July 2015
Responded to telephone inquiries, provided quality service to callers while assisting with appointment scheduling, registration, profile updates, prescription requests, and placing in contact with clinical staff. Successfully led new advocate training for 11 employees. Achieved quality score of 96% within six months, exceeding contact center target.
SKILLS
• Creative Problem Solving
• Clear Verbal and Written Communication
• Retail and Customer Service
• Project Management
• Interpersonal Skills