ARASELI VALENCIA
Compton,USA
Summary
Diligent Claims Representative with a robust background in managing and processing claims efficiently, consistently achieving high levels of customer satisfaction. Proven track record in successfully resolving complex cases while ensuring strict compliance with industry regulations. Expertise in analytical problem-solving and effective communication enhances the ability to navigate challenging situations and foster positive client relationships. Committed to delivering exceptional service and driving continuous improvement in claims management processes.
Overview
11
11
years of professional experience
Work History
Claim Specialist
Social Security Administration
03.2015 - Current
- Evaluated and processed claims for Social Security benefits, ensuring compliance with federal regulations.
- Analyzed complex case files to determine eligibility and resolve discrepancies in claims data.
- Collaborated with cross-functional teams to enhance claim processing efficiency and accuracy.
- Trained and mentored junior staff on best practices in claims adjudication and customer service.
- Implemented process improvements that streamlined workflow, reducing turnaround times for claim decisions.
- Conducted quality assurance reviews of processed claims to maintain high standards of accuracy and compliance.
- Developed training materials and conducted workshops to improve team knowledge of policies and procedures.
- Led initiatives to optimize the use of claims processing systems, enhancing user experience for staff and clients.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Followed up with customers on unresolved issues.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Conducted detailed investigations into suspicious claims, successfully identifying and addressing fraudulent activities.
- Analyzed claim documents to ensure accuracy and compliance, mitigating risk of financial loss.
- Streamlined documentation workflow, enabling quicker claim resolution and enhancing customer satisfaction.
- Provided accurate information on policies, procedures, and documentation needed for claims processing.
- Assisted clients in navigating online services, enhancing user experience and accessibility.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Responded to employee inquiries regarding policies, benefits, and procedures with clarity.
- Contributed to performance evaluation processes by compiling feedback and documentation.
- Filed paperwork, sorted, and delivered mail and maintained office organization.
- Answered and redirected incoming phone calls for office.
- Evaluated retirement plans to ensure compliance with regulatory standards and client needs.
- Conducted comprehensive retirement assessments, identifying areas for improvement in client portfolios.
- Streamlined processes for tracking client progress towards retirement goals, improving efficiency by 20%.
- Analyzed medical records for compliance with regulatory standards and organizational policies.
- Implemented electronic health record systems to enhance data accessibility and accuracy.
- Conducted audits of medical documentation to ensure completeness and integrity of patient information.
Executive Assistant
Lieberman Broadcast Media
06.2014 - 03.2015
- Organized and coordinated conferences and monthly meetings.
- Responded to emails and other correspondence to facilitate communication and enhance business processes.
- Processed travel expenses and reimbursements for executive team and senior management group.
- Screened calls and emails and initiated actions to respond or direct messages for managers.
- Performed Customer service functions by answering employee requests and questions.
- Filed papers and documents into employee files.
- Partnered with human resources manager on research and special projects.
- Created photocopies, faxed documents and performed other clerical functions.
- Supervised the ordering, acquisition, inventorying, and disposition of office material.
- Prepared and set up for new employee orientations.
- Adhered to security policy to protect employees, guests and visitors.
- Filed and compiled corporate documents, records and reports to streamline office flow.
- Reviewed company reports and gathered information to provide research support.
- Managed and organized confidential information to maintain privacy.
- Answered phones, handled calls and fielded appointment requests to assist supervisors.
- Inspected faulty office equipment and arranged repairs.
- Coordinated packages and correspondence with external sources.
- Updated and maintained business contact information using digital database.
- Coordinated schedules by booking and canceling meeting venues.
- Ordered and distributed office supplies by adhering to fixed office budget.
- Utilized job-related software to prepare invoices, letters and memos.
- Read and analyzed incoming memos, submissions and reports to determine significance and distribute to proper staff members.
- Prepared responses to correspondence containing routine inquiries.
- Answered phone calls to direct callers to appropriate parties or take messages.
- Attended meetings to record minutes.
- Prepared agendas and made arrangements, such as coordinating catering for luncheons, for committee, board and other meetings.
- Filed and retrieved corporate documents, records and reports.
- Performed general office duties, such as ordering supplies, maintaining records management database systems and performing basic bookkeeping work.
- Provided clerical support to other departments.
- Arranged for employee onboarding by scheduling training and organizing training material.
- Made travel arrangements for executives.
- Researched and cataloged supporting documentation and data for management projects.
- Compiled, transcribed and distributed minutes of meetings.
- Managed and maintained executives' schedules.
- Operated scanners to make copies of correspondence and other printed material.
- Used advanced Excel functions and calculations to develop reports and lists.
- Assisted in coordination of company events( Award Shows, screenings and holiday parties).
- Arranged and prepare materials needed for sales presentations to clients and media departments of advertising agencies.
- Created presentations for advertising with analytical information pertaining to clients.
- Created and maintained an organization unit for entire buildings to lower the cost of office supplies by 20%.
- Held weekly meetings to organize and distribute tasks for each new product launch with marketing teams.
- Delivered engaging and polished presentations to highlight brands' products and draw favorable competitor comparisons.
Education
Bachelor of Science - Political Science And Government
University of California, Irvine
Irvine, CA06.2014
Bachelor of Science - Chicano Studies
University of California, Irvine
Irvine, CA06.2014
Associate of Arts - Liberal Arts And Sciences
East Los Angeles College
Monterey Park, CA06.2010
Skills
- Electronics expertise
- Experienced with Microsoft Office applications
- Form data integrity checks
- Strategic planning
- Fraud analysis
- Analytical decision-making
- Attorney Collaboration
- Claims management
Languages
Spanish
Timeline
Claim Specialist
Social Security Administration
03.2015 - Current
Executive Assistant
Lieberman Broadcast Media
06.2014 - 03.2015
Bachelor of Science - Chicano Studies
University of California, Irvine
Associate of Arts - Liberal Arts And Sciences
East Los Angeles College
Bachelor of Science - Political Science And Government
University of California, Irvine