Brandiee Hernandez

• Managed approximately 40 incoming calls per day from customers
• Providing consultative support based on knowledge and expertise in insurance and healthcare
• Provide courteous assistance to customer inquiries by phone for one line of business Commercial or Government Programs.

• Process entry level suspended claims and adjustments in an accurate and timely manner.

• Establish and maintain team working relationships with customers, co-workers and other resources as needed.

• Recommend improvements in workflow and processing.

• Complete special projects on time with high quality.

• Represent Delta Dental in a professional manner both internally and externally.

• Assists other areas of Delta Dental to meet corporate goals.

• Maintain strict confidentiality

• Perform other duties as assigned

• Billing, Claim/Tar, Denied codes

• Examine 30 Unemployment claims for pertinent information in order to adjudicate claims
• Remote work in a virtual desktop environment
• Accessing following software: SharePoint, CUBS, TECH, Info Image, Microsoft Office Suite including Outlook, Word, Excel, and Teams
• Conduct phone interviews with claimants and employers as necessary to gather supportive evidence in order to adjudicate claims
• Analyze information and facts gathered from interviews and documentation related to claim
• Compare information available with established standards for adjudicating decisions in favor of either employer or claimant
• Write clear summary of facts pertaining to claim and reference the correct corresponding legal precedent located in the Benefit Determination Guide for State of California
• These completed reports are used in entering decisions into EDD databases and in the event of an appeal heard in court
• Gathers and compiles documents and prepares written responses to unemployment claims
• Contacts client companies for detailed facts and documentation to support the response to the state agency
• Organizes documents necessary for files
• Responds to calls from claims investigators at various state unemployment offices, relaying separation and payroll information
• Decision-making is moderate, governed by procedure, guided by policy and objective, and focused on daily operations
• Prepares written responses to unemployment claims based upon a summary of facts compiled from files, personnel records and interviews in a timely manner
• Provides personnel employment information and verification
• Maintains frequent telephone contact with management and supervisors from client companies, gathering facts necessary to determine if unemployment claims are disputable and explaining unemployment rules, regulations, decisions and options
• Organizes and compiles files related to claims, including claim documents, termination reports, counseling statements, data collection sheets, wage statements, supporting documentation and notes from interviews
• Works closely with HR team to ensure coordinated effort to minimize impact on client while providing an integrated service.

• Managed 30 offices, sweeping, buffing, mopping, dusting, vacuuming, emptying trash cans, polishing woodwork, wiping down tables, scrubbing toilets, and washing windows.