Aliaa Sanadeki
TUCSON,AZ
Summary
Proven ability to collaborate effectively across departments. known for clear communication, problem-solving skills, and ensuring accurate and timely resolution. Seeking to advance to level 2 to further contribute to process improvement, team efficiency,and quality outcomes within the appeals process.
Overview
10
10
years of professional experience
Work History
Grievances and Appeals Coordinator
Centene
07.2024 - Current
- Review and process provider appeal submission related to denied claims , authorization, and reimbursement dispute , ensuring compliance with regulatory guidelines.
- Analyze appeal documentation and correspondence to determine appropriate routing for clinical or administrative review.
- Ensure timely and accurate resolution of appeals documentation for clinical or administrative review and maintaining compliance with internal slanderers.
- Monitor and track appeal deadlines ro ensure timely resolution and prevent regulatory violation.
- Draft clear and accurate appeal responses and determinations professionally to providers.
- Support peers by sharing procedural knowledge, answering case handling questions.
PROVIDER SERVICES REPRESENTATIVE
Centene
01.2022 - 07.2024
- Responded quickly to meet provider needs and resolve problems.
- Analyzed and collected Provider information to prepare service reports.
- Used job-related software in order to resolve the Provider claim issue.
- Navigated multiple computer systems and applications and utilized search tools to find information.
- Referred unresolved customer grievances to designated departments for further investigation.
- Document all notes and steps been done, in order to resolve the issue, or any information been provided.
CUSTOMER SERVICE REPRESENTATIVE
Alorica
11.2020 - 01.2021
- Greeted customers by name and displayed respectful attitude, helping develop rapport with customer base.
- Responded to telephone inquiries and complaints following standard operating procedures.
- Investigated and researched issues to determine root causes and appropriate resolution methods.
- Maintained knowledge of company products to provide helpful suggestions and recommendations to customers.
- Referred unresolved customer grievances to designated departments for further investigation.
- Used job-related software to complete contract forms, prepare change of address records or issue service discontinuance orders.
- Gave accurate and appropriate information to answer questions, troubleshoot issues and resolve complaints.
PROFICANAL INTERPRETER
Cyracom international Inc - Language solutions
02.2018 - 07.2019
- Responding quickly to meet customer needs and resolve problems.
- Listened to speakers' statements to determine meanings and to prepare translations/English to Arabic, and visversa.
- Compiled information on content and context of information to be translated and on intended audience.
- Identified and resolved conflicts related to meanings of words, concepts, practices and behaviors.
PHARMACY TECHNICIAN
CVS Health
03.2015 - 06.2017
- Compounded intravenous medications using sterile techniques.
- Organized medications for dispensing by profiling prescriptions and calculating quantities.
- Handled doctor calls and medication deliveries in facilitation of prescription orders.
- Input patient and prescription information to produce product labels and assist in the prescription filling process.
- Reported prescription errors to pharmacists on duty.
- Stocked and replenished shelves to remove out-of-date items from inventory.
- Verified insurance data and contact information to complete prescription refill requests.
- Entered prescription information into computer databases.
- Received written prescription and refilled requests and verified that information is complete and accurate.
- Assisted customers by answering simple questions, locating items and referring them to pharmacist for medication information.
Education
Bachelor of Science (B.S.) - Pharmacy
Petra University
07.2016
Skills
- Teamwork and collaboration
- Problem-solving
- Time management
- Attention to detail
- Multitasking Abilities
- Critical thinking
- Organizational skills
- Active listening
- Decision-making
- Relationship building
- Legal research
- Self motivation
- Interpersonal skills
- Effective communication
Timeline
Grievances and Appeals Coordinator
Centene
07.2024 - Current
PROVIDER SERVICES REPRESENTATIVE
Centene
01.2022 - 07.2024
CUSTOMER SERVICE REPRESENTATIVE
Alorica
11.2020 - 01.2021
PROFICANAL INTERPRETER
Cyracom international Inc - Language solutions
02.2018 - 07.2019
PHARMACY TECHNICIAN
CVS Health
03.2015 - 06.2017
Bachelor of Science (B.S.) - Pharmacy
Petra University
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