Summary
Overview
Work History
Education
Skills
Affiliations
Accomplishments
References
Timeline
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Alyssa Mellizo

Alyssa Mellizo

Santee,CA

Summary

Results-driven Claims Examiner recognized for exceptional problem-solving skills and meticulous attention to detail. Experienced in fraud investigation and policy evaluation, ready to leverage expertise to enhance claims accuracy and support organizational goals.

Overview

11
11
years of professional experience

Work History

Claims Examiner

GEICO, Government Employees Insurance
Poway, California
07.2021 - 08.2025
  • Reviewed claims for accuracy and compliance with policy guidelines.
  • Evaluated documentation to assess claim eligibility and validity.
  • Conducted thorough investigations of discrepancies through detailed analysis.
  • Communicated with policyholders to gather information and clarify claim details.
  • Managed workloads by prioritizing tasks based on urgency.
  • Provided training to new examiners on best practices in claims processing.
  • Maintained accurate records of claims activities for auditing purposes.
  • Reviewed medical records and documents to determine coverage eligibility of claims for insurance benefits.
  • Negotiated settlement terms with claimants within authorized limits.
  • Identified potential fraudulent claims and conducted detailed investigations.
  • Monitored reserves to ensure adequate funds were available for claim settlements.

Senior Pharmacy Technician

OptumRx
San Diego, California
09.2014 - 07.2021
  • Collaborated with healthcare providers to resolve prescription-related issues efficiently.
  • Trained new pharmacy technicians on procedures and best practices for compliance.
  • Utilized pharmacy management systems to track prescriptions and patient information securely.
  • Verified that all incoming prescriptions were accurate and complete prior to dispensing them.
  • Maintained and updated patient profiles, including allergies, medications and lab results.
  • Organized workflow within the pharmacy department by assigning tasks appropriately among staff members.
  • Processed third-party insurance claims for reimbursement of medications.
  • Ensured compliance with state and federal regulations related to pharmacy operations.
  • Created new customer profiles and updated demographics, allergies, and new medications in pharmacy computer systems.
  • Transmitted claims to insurance companies for payment and reconciled EOBs.
  • Developed and maintained positive relationships with patients and healthcare providers.
  • Organized and led team meetings to discuss workflow improvements and challenges.

Education

Associate of Applied Science - Pharmaceutical Sciences

Grossmont College
El Cajon, CA
12-2012

Skills

  • Claims processing
  • Fraud investigation
  • Policy evaluation
  • Medical claims analysis
  • Settlement negotiation
  • Regulatory compliance
  • Customer service
  • Transcribing

Affiliations

  • I am an avid reader who loves many different genres of books, especially books about local history.
  • I am a film buff who really enjoys lesser known, small budget, and student films.

Accomplishments

  • Subject matter expert in policy contracts, especially for California policies.
  • Top quartile in results for 3 years.

References

References available upon request.

Timeline

Claims Examiner

GEICO, Government Employees Insurance
07.2021 - 08.2025

Senior Pharmacy Technician

OptumRx
09.2014 - 07.2021

Associate of Applied Science - Pharmaceutical Sciences

Grossmont College

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