Summary
Overview
Work History
Education
Skills
Timeline
Generic

CARMEN MORALES

Laveen,Arizona

Summary

Knowledgeable, articulate communicator with more than ten years of customer service experience. Maintaining strong decision making and problem solving abilities as well as excellent time management skills. Possessing multitude of versatile skills transferable into any position to create and maintain high levels of efficiency and productivity. Outgoing leader with experience overseeing multiple tasks and managing employees successfully. Hardworking professional committed to providing outstanding customer service and assistance.

Overview

13
13
years of professional experience

Work History

Claims Representative

Molina Healthcare
12.2023 - Current
  • Analyzed and addressed escalated claims to resolve issues quickly.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Researched and analyzed complex claims to determine next steps and possible outcomes.
  • Updated claims system to track claim status and provide relevant information to other department.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Met customer call guidelines for service levels, handle time and productivity.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Verified insurance coverage and eligibility for medical services .
  • Researched billing errors and discrepancies to initiate corrective action.
  • Entered client details and notes into system for interdepartmental access and review.

Home Health Aide/ Caregiver

Abrio Family Services
02.2023 - Current
  • Performed laundry, grocery shopping and other light housekeeping duties as instructed
  • Assisted patients with dressing, grooming and feeding needs, helping to overcome, and adapt to mobility restrictions.
  • Provided mobility assistance such as walking and regular exercising.
  • Assisted disabled clients to support independence and well-being.
  • Reported unusual or urgent circumstances in patients' condition or environment immediately to nurse supervisor.
  • Developed rapport to create safe and trusting environment for care.
  • Developed individual care plans for clients based on specific needs.
  • Transported clients for medical and personal outings.
  • Scheduled and coordinated medical appointments.
  • Assisted with dressing guidance, grooming, meal preparation, and medication reminders.

APPRAISAL COORDINATOR - TEAM LEAD

LoanDepot
02.2021 - 10.2023
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
  • Resolved issues through active listening and open-ended questioning, escalating major problems to manager
  • Maximized performance by monitoring daily activities and mentoring team members
  • Assisted in data entry for residential reviews of appraisals and evaluations
  • Monitored completion of reports and turnaround of orders for fee and staff appraisers
  • Communicated with fee appraisers regarding orders, reports and assignment schedules
  • Trained team members on new procedures and products
  • Cross-trained existing employees to maximize team agility and performance.
  • Monitored accounts to verify compliance with payment terms and schedules.

CREDENTIALS SPECIALIST

Phoenix Union High School District
01.2015 - 02.2021
  • Accurately documented, researched and resolved customer service issues
  • Completed Graduation list for graduating senior class
  • Reviewed credits and test scores for all students
  • Complied multiple reports and reviewed for accuracy
  • Followed district polices.
  • Created and managed project plans, timelines and budgets.

MEDICAL BILLING/ COLLECTION SPECIALIST

Arizona Heart Anesthesia
01.2014 - 08.2015
  • Review patient bills for accuracy and completeness and obtain any missing information
  • Follow up on unpaid claims within standard billing cycle time frame
  • Call insurance companies regarding any discrepancy in payments if necessary
  • Composed and drafted all outgoing correspondence and reports for managers
  • Verified and created claim numbers by communicating with various insurance companies
  • Managed hundreds of accounts receivable accounts working directly with the Financial Management Office
  • Performed accounts receivable duties including invoicing, researching chargebacks, discrepancies and reconciliations
  • Handled customer inquiries and suggestions courteously and professionally
  • Updated account information to maintain customer records.
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Monitored customer accounts to identify and rectify billing issues.
  • Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
  • Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
  • Prepared and submitted monthly billing reports to management for financial overview.
  • Used data entry skills to accurately document and input statements.
  • Processed payment via telephone and in person with focus on accuracy and efficiency.

LOAN OFFICER/ COLLECTIONS

Auto Equity Loans
02.2013 - 11.2013
  • Analyze applicants' financial status to obtain loan
  • Explain to customers the different types of loans and payment options
  • Review loan agreements to ensure that they are complete and accurate according to policy
  • Handle customer complaints and take appropriate action to resolve them
  • Collect Monthly Payments and delinquent accounts.

CERTIFIED NURSING ASSISTANT

LifeCare Center of South Mountain
02.2011 - 05.2012
  • Provided nursing assistance to residents in a 120-bed long-term-care facility
  • Ensured the accurate, timely flow of information by maintaining thorough patient records and updating healthcare team on patients' status
  • Maintaining Privacy of Patients as mentioned by HIPAA Regulations
  • Caring for Patients & Assuring their Safety.
  • Answered call lights and supported patient comfort and safety by adjusting bed rails and equipment.
  • Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
  • Checked patient vitals such as temperature, blood pressure, and blood sugar levels.
  • Delivered individualized patient care by recording vital signs, documenting observations, administering treatments, and evaluating patient needs.
  • Offered immediate assistance in emergency and routine paging situations to evaluate needs and deliver care.

Education

High School Diploma -

Tempe High School
Tempe, Arizona
01.2010

Skills

  • Accurate and detailed Quick learner
  • Ability to Plan, Organize and Prioritize Work Office support (phones, faxing, filing)
  • MS Windows proficient
  • Excellent communication skills Customer service-oriented
  • Professional phone etiquette
  • Project Management
  • Employee Training
  • Microsoft Excel
  • Account Management
  • Data Analysis
  • Payment Processing
  • Dispute Resolution
  • Collections Management
  • Account Reconciliation

Timeline

Claims Representative

Molina Healthcare
12.2023 - Current

Home Health Aide/ Caregiver

Abrio Family Services
02.2023 - Current

APPRAISAL COORDINATOR - TEAM LEAD

LoanDepot
02.2021 - 10.2023

CREDENTIALS SPECIALIST

Phoenix Union High School District
01.2015 - 02.2021

MEDICAL BILLING/ COLLECTION SPECIALIST

Arizona Heart Anesthesia
01.2014 - 08.2015

LOAN OFFICER/ COLLECTIONS

Auto Equity Loans
02.2013 - 11.2013

CERTIFIED NURSING ASSISTANT

LifeCare Center of South Mountain
02.2011 - 05.2012

High School Diploma -

Tempe High School

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CARMEN MORALES