ALEXIS PALETZ
Aetna/CVS
Burlington,NC
2025
years of professional experience
1
Certification
Experienced with processing diverse insurance claims and ensuring compliance with regulatory standards. Utilizes attention to detail and analytical skills to identify discrepancies and expedite resolutions. Track record of maintaining accurate records and delivering exceptional customer service.
Work History
International Claims Processor
1 Year- Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Served as subject matter expert, delivering high quality claim adjudication for members and providers. Handled customer service inquiries and problems. Applies medical necessity guidelines, identifies discrepancies, and applies all cost containment. Measures to assist in the claim adjudication process. Ensures all compliance requirements are satisfied, and all payments are made against company practices and procedures. Identified and reported claim overpayments, underpayments, and other irregularities to enhance compliance and accuracy. Performs claim rework calculations. Ensured accuracy and timeliness of claims processing, contributing to overall operational effectiveness.
- Processed insurance claims accurately, ensuring compliance with company policies and regulations.
- Reviewed and analyzed claim documentation to identify discrepancies and resolve issues efficiently.
- Collaborated with cross-functional teams to streamline claims processing workflows and improve turnaround times.
1 Year
- Answered incoming calls from patients and other doctors offices. Verified Insurance via computer and phone. Scanning in patient ID and Insurance cards. Updated patients charts and worked with the doctors on documentation and notifying patients of any changes. Oversight of the office staff and patient documents. Coordinating with other offices on patient documentation and changes. In charge of keeping the office well supplied and helping our team out wherever it is needed. Making sure company rules and regulations were followed on the computer and in the office.
- Front desk clerk
Unit Coordinator in Trauma ER
3 Years- Answered phones and directed them to appropriate parties, managed physician orders efficiently. Adjusting and input patient information. Supported staff by taking vitals, maintaining cleanliness, and delivering orders to pharmacy and radiology. Calling the operator with urgent matters for alerting physicians on the floors of incoming traumas, codes and other matters. Handling and resolving patient information and care. Communicated with physicians, transfer centers, floors, and families daily to ensure proper patient care and timely transport.
- Coordinated patient admissions, discharges, and transfers, ensuring smooth operational workflows.
- Managed scheduling for nursing staff, optimizing resource allocation and enhancing team efficiency.
- Implemented process improvements that streamlined communication between departments and reduced delays.
Receptionist / Secretary
- Answered phones, took customers' orders, addressed questions and concerns in person and over the phone, and managed payment information and invoices while typing and printing shipment details. Managed complex client requests and complaints. Coordinated maintenance of reception area equipment, furniture, lighting, waivers, and brochures to ensure a welcoming environment.
Customer Service
- Answered and resolved clients inquire through the use of effective listening, written and verbal communication skills. Ensured every customer found everything they needed and inquired about products they needed help finding. Resolved issues with customers, made sure my register was appropriately accounted for, and helped coworkers with anything they needed. Maintained productivity, efficiency, and quality levels, ensuring adherence to company standards.
- Resolved customer service escalations to promote mutually beneficial outcomes.
- Improved team efficiency with thorough training on customer service protocols.
- Delivered exceptional customer service by addressing client needs promptly and professionally.
Team Leader
- Opened the store, prepared food and product for sale, cleaned and sanitized. Took inventory, made preparations for the next day, and received shipments. Oversaw training new hires and teaching sales techniques to employees.
Education
- Diagnostic Medical Sonography
- Health Administration
Continuing education; Majoring in
- Medical Admin Business
Graduated
- High school graduate
Graduated
Skills
Claims Processing
Claims Management
Insurance Policy Review
Risk management
Data analysis
Business analytics
Process optimization
Electronic Records
Healthcare Software
Client support
Revenue management
Budgeting
Inventory management
Performance optimization
Program evaluation
Research analysis
Team leadership
Negotiation skills
Relationship management
Certification
Microsoft Office Specialist Word 2016, PowerPoint 2016, Microsoft Office Excel 2016
Disclaimer
REFERENCES AND OTHER RELEVANT DOCUMENT AVAILABLE UPON REQUEST
Timeline
International Claims Processor
Aetna/CVS
01.2024 - 01.2025Read More
AssociatesMD
01.2022 - 01.2023Read More
Unit Coordinator in Trauma ER
Aventura hospital and medical center.
01.2019 - 01.2022Read More
Broward College
from Health Administration
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McFatter Tech
from Medical Admin Business
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Chaminade-Madonna College Preparatory
from High school graduate
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Receptionist / Secretary
PressRite and DLP Hardware
2016 - 2019Read More
Customer Service
Publix
2013 - 2017Read More
Team Leader
Dunkin Donuts
2012 - 2014Read More
Keiser University
from Diagnostic Medical Sonography
Read More