Amber Arreseigor
Las Vegas,NV
Summary
Experienced with managing appeals processes efficiently and effectively. Utilizes strong analytical skills and effective communication to resolve complex cases. Knowledge of regulatory standards and compliance ensures smooth operations and client satisfaction.
Developed strong communication and problem-solving skills in fast-paced customer support environment. Skilled in handling complex inquiries and resolving issues efficiently, ensuring customer satisfaction. Looking to transition into new field where these transferrable skills can be applied effectively.
Thrives in high-pressure environments where attention to detail and effective communication are crucial. Developed expertise in analyzing complex information and resolving issues efficiently. Seeking to leverage these transferrable skills in new and dynamic role.
Overview
3
3
years of professional experience
Work History
Appeals Representative
United Healthcare Commercial Appeals
03.2024 - Current
- Reviewed and analyzed appeal cases to ensure compliance with policy guidelines.
- Collaborated with healthcare providers to gather necessary documentation for appeals processing.
- Communicated effectively with members regarding appeal status and resolution outcomes.
- Developed and maintained comprehensive case files to support decision-making processes.
- Implemented quality assurance measures to enhance accuracy in appeal decisions and documentation.
- Expedited the appeals process for faster resolutions by streamlining procedures and workflows.
- Decreased case backlog by effectively prioritizing and managing high-volume caseloads.
- Conducted comprehensive reviews of claim denials, identifying errors or discrepancies that led to successful reversals on appeal.
- Conducted detailed audits on case files, ensuring accuracy and completeness of information for better decisionmaking.
- Supported fellow Appeals Representatives through peer coaching and knowledge sharing, fostering a collaborative work environment.
- Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
Customer Representative
United Healthcare Medicare
01.2023 - 03.2024
- Assisted with Medicare beneficiaries with plan inquiries, coverage details, and enrollment processes. Educated clients on Medicare advantage, Part D and Medigap plans to help them make inform decisions.
- Handled escalated calls regarding issues, billing disputes, and all benefit explanations with empathy and efficiency.
- Adhered to CMS regulations and HIPPA standards while handling sensitive information.
- Assisted in processing claims and ensuring timely resolution of issues.
- Maintained strong working knowledge of Medicare regulations, ensuring accurate information dissemination to clients.
- Supported department goals by consistently meeting or exceeding established metrics related to call quality, timeliness, and accuracy.
Education
High School Diploma -
Antelope Valley Youth-build
Palmdale, CA06.2018
Skills
- Case file management
- Member communication
- Documentation gathering
- Appeal case analysis
- Caseload prioritization
- Policy compliance adherence
- Claims processing assistance
- Strong analytical skills
- Medical terminology
- Time management
- Claims investigation
- Claims processing
- Organizational skills
- Escalated issue resolution
- Medicare regulations
- High-volume caseload management
- HIPAA compliance
- Communication skills
- Healthcare industry experience
- CMS guidelines
Timeline
Appeals Representative
United Healthcare Commercial Appeals
03.2024 - Current
Customer Representative
United Healthcare Medicare
01.2023 - 03.2024
High School Diploma -
Antelope Valley Youth-build