Summary
Overview
Work History
Education
Skills
Timeline
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Benny Polanco

Philadelphia,PA

Summary

Fraud Claim Analyst with over 15 years of experience in claims processing and fraud analysis, specializing in resolving complex billing disputes within regulatory frameworks. Proven expertise in data entry and Microsoft Office applications enhances customer service outcomes, ensuring high-quality assurance, and effective problem-solving. Dedicated to leveraging extensive industry knowledge to deliver precise claim resolutions, while continuously advancing investigative skills.

Overview

14
14
years of professional experience

Work History

Fraud Claim Analyst, Claim Specialist

Ttec
10.2020 - Current
  • Company Overview: TeleTech
  • Resolve Credit Card customer billing disputes within the bank's policies and procedures and comply with industry regulations
  • Investigate and decide daily incoming claims using multiple systems and tools; resolve differences; answer service requests and inquiries received from various channels
  • May debit or credit customers' accounts as appropriate, process provisional credit, chargebacks, Representment, or update customers regarding pending claims with integrity
  • Manage claims assigned and review them to be routed to the correct queue when unable to resolve the issue
  • Research general customer account inquiries as appropriate keeping problem-solving skills, and demonstrate the ability to work independently with minimal supervision and excellent organizational skills
  • Show the ability to think independently, evaluate situations, and take appropriate action to resolve with minimal direction
  • Experience in a production environment for 6 years
  • Detailed and quality-oriented and ability to research and work within several computer applications simultaneously
  • Utilize all applicable system functions available ensuring accurate and timely claim processing and meeting deadlines, while using word processing, spreadsheet, database, internet, and e-mail
  • Analyze electronic correspondence handling the System used to process correspondence that is scanned in the system to send to the right channels
  • TeleTech

CSR I- Prepaid Services

Ttec
07.2020 - 10.2020
  • Company Overview: TeleTech
  • Instructing users on prepaid card features such as when funds will be available, balances
  • Educating users on which and to whom to ask about future deposits
  • Assisting users in resetting PINs, User IDs, and website passwords
  • Updating personal data when the sponsor’s policy allows it
  • TeleTech

Member Account Representative

Sykes Enterprise Inc.
12.2017 - 09.2019
  • Manage an average of multiple interactions per day and receive inquiries from existing customers while maintaining exceptional communication skills to assist customers with billing status, cancelations, or assistance with order processing

Benefits Administrative Senior Associate

CONDUENT
Cherry Hill, NJ
09.2017 - 12.2017
  • Carefully analyzed a situation and escalated it to the appropriate specialists
  • Provided calculations and prepared statement records after verifying insurance plans and coordinating draft invoices when necessary
  • Determine coverage and complete eligibility verification
  • Verified sensitive data to keep the database confidential and advised clients when making changes to their medical insurance plans
  • Handled private medical information while inputting information into a computer system
  • Answered inbound calls related to billing, enrollment, and out-of-pocket expenses for different medical service providers using my experience with basic insurance guidelines
  • Helped employees enroll in the company’s services by guiding them through the patient portal and understanding premiums while providing exceptional customer service

Branch Manager

CFSC The Check Cashing Place
Brooklyn, NY
12.2010 - 03.2015
  • Dedicated to customers’ daily transactions while maintaining excellent customer service
  • Counted currency, and coins and received them to prepare them for deposit or shipment to subsidiary banks or the Federal Reserve Bank
  • Examined checks for endorsements and verified information such as the legality of documents

Education

Medical Billing and Coding Certification - Health Information Technology

DeVry University
Chicago, IL
03-2027

Some College (No Degree) -

Accident And Health Insurance Producer License
Philadelphia
01-2020

Undergraduate -

Long Island University
NY

Some College (No Degree) -

Manhattan Institute
New York, NY

Skills

  • Microsoft Office
  • Word
  • Excel
  • PowerPoint
  • Data entry
  • Analytical mind
  • Claim processing
  • Computer Navigation Proficiency
  • Production
  • Quality background
  • Problem-solving
  • Investigative mind
  • Evidence-based decision making
  • Analytical problem solving
  • Intrusion detection
  • Deadline adherence
  • Data integrity assurance
  • Time management
  • Critical thinking
  • Microsoft office
  • Data processing
  • Verbal and written communication

Timeline

Fraud Claim Analyst, Claim Specialist

Ttec
10.2020 - Current

CSR I- Prepaid Services

Ttec
07.2020 - 10.2020

Member Account Representative

Sykes Enterprise Inc.
12.2017 - 09.2019

Benefits Administrative Senior Associate

CONDUENT
09.2017 - 12.2017

Branch Manager

CFSC The Check Cashing Place
12.2010 - 03.2015

Medical Billing and Coding Certification - Health Information Technology

DeVry University

Some College (No Degree) -

Accident And Health Insurance Producer License

Undergraduate -

Long Island University

Some College (No Degree) -

Manhattan Institute

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Benny Polanco