Daniel Alejandro Flores Galdamez

Skills

Customer Service Excellence

Health Insurance Knowledge (HIPAA Compliance, Benefits, Claims, Authorizations)

Call Center Operations

Quality Assurance & Performance Metrics

Problem-Solving & Analytical Thinking

Strategic Planning & Process Improvement

Team Leadership & Mentorship

Subject Matter Expertise (SME)

Floor Support & Agent Coaching

Training & Development

Empathy & Active Listening

Conflict Resolution & De-escalation

Communication Skills (Verbal & Written)

Time Management & Prioritization

Attention to Detail

Multi-Tasking in High-Pressure Environments

Collaboration with Healthcare Providers

Appeals & Denials Processing

Claims Investigation & Resolution

Data Entry & Documentation Accuracy

Customer Satisfaction Optimization

Performance Monitoring & Reporting

Knowledge Base Management

Insurance Policy Explanation

Call Handling Efficiency (High Volume / Fast-Paced Environment)

About

Blue Cross Blue Shiel of Michigan Campaign
Costumer Service Representative Role
JUNE, 2023 - PRESENT
Recognized as the Top Performer Agent of the Month five times in
two years, consistently achieving 100% in Quality Call Metrics and
Customer Satisfaction Surveys, while maintaining an average Call
Handle Time of 475–500 seconds — significantly outperforming the
1,110-second target. Always keeping safe Personal Health Info
following HIPAA.
As a Customer Service Representative, I handled inbound calls to
provide members and doctors with detailed information about their
insurance policies, including covered services, available benefits,
authorization requirements and estimated costs for medical
procedures and prescriptions. Collaborated with healthcare providers
to address intricate claim issues, authorization denials or appeal
denials, applying my analytical and detail-oriented skills.
Subject of Matter Expert (SME) / Floor Support
DECEMBER, 2023 - PRESENT
As a Floor Support and Subject Matter Expert for the campaign I
was assigned to, I was responsible for overseeing a team of 15
agents, and at times up to 35–40 individuals simultaneously.
My primary role involved providing on-the-spot guidance to
agents regarding product knowledge and procedural inquiries,
always ensuring that responses were aligned with established
protocols and knowledge base articles. I also assisted team
members in delivering information to callers with empathy and
clarity. Through my support methodology—focused on
accessibility of resources and enhancing information search
and analysis skills—I helped agents significantly improve their
call-handling capabilities.
Additionally, I worked closely with my supervisor as a trusted
point of contact for coaching agents with multiple areas of
opportunity. I developed online quizzes to reinforce product
knowledge and created analytical tables to track and interpret
performance based on the quiz results. I also led virtual training
sessions using platforms such as Microsoft Teams and
conducted roleplays to help agents handle complex or "tricky"
call scenarios more effectively