CLAUDIA I. NAVA
Insurance Industry
4648 N. Thatcher Avenue,IL
Summary
Experienced Insurance Professional with 20+ years in Customer Care, Underwriting, and Business Process Optimization. Solid foundation in industry practices, with a strong record in customer service and policyholder relations. Proficient in Microsoft Office, bilingual in Spanish and English, and known for exceptional interpersonal skills and adaptability. Seeking to apply analytical expertise to advance success in the Insurance and Brokerage sector
Overview
20
20
years of professional experience
1
1
Certification
Work History
Business Process Specialist
Next Level Solutions
Springfield , MO
7.11-202 - 05.2023
- Liason to the individual business areas withing the organization evaluating, planning and implementing improvements
- Served as primary interface between stakeholders and IT Department, communicating proposed implementations of new systems and current system upgrades.
- Investigated and resolved Billing problems with self-motivated and knowledgeable approach based on sound understanding of failure analysis and statistical methodology.
- Collected and analyzed user stories and leveraged data to enhance and expand future process planning and solution strategies.
- Worked directly with clients to accurately define nebulous business requirements, designing operational frameworks suited to each customer's requirements.
Policyholder Service Specialist
OMSNIC & Fortress Insurance Companies
Rosemont , IL
02.2009 - 07.2022
- Responded promptly to customers' concerns and coordinated swift resolutions to handle service issues.
- Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Answered inbound calls, chats and emails to facilitate customer service. Handled high volume calls each day.
- Demonstrated excellent communication skills in resolving product and consumer complaints.
- Mentored new employees on procedures and policies to maximize team performance.
- Used proven techniques to de-escalate angry customers during telephone interactions.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Assisted customers with making payments or establishing payment plans to bring accounts current.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Informed customers about billing procedures, processed payments and provided payment option setup assistance.
- Set up and activated customer accounts.
- Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
- Conducted testing of forms, rates, invoices, website, worked close with the Project manager, and Developers
Senior Provider Relations Coordinator
Great West Healthcare
Rosemont , IL
01.2003 - 11.2008
- Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues.
- Investigated concerns such as billing and claims questions on behalf of providers.
- Stayed current on available policies and plans.
- Enhanced client satisfaction ratings by resolving disputes and partnering with healthcare providers to clarify issues.
- Explained policies, procedures and services to Hospital and Medical groups, during site visits.
- Collaborated with clinical and administrative staff to meet patient needs.
Utilization Review Assistant
One Health Plan of Illinois
Rosemont , IL
01.1999 - 2003
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
- Kept detailed documentation on all utilization reviews by accurately documenting the patients file.
- Protected medical information against unauthorized access, loss or corruption by consistently following security protocols.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Handled high volume calls each day
Education
Associates - Applied Science, Business Administration
Robert Morris College, National Education Center
01.1999
Diploma -
Carl Schurz High School
01.1992
Skills
- Clear Communication
- Problem Resolution
- Microsoft Office
- Reliable & Trustworthy
- Fluent in Spanish
- Team Building
- Organizational Skills
- Planning & Organizing
- Conflict Resolution
- People Skills
- Active Listening
- Customer Service
- Good Work Ethic
- Flexible Schedule
- Quality assurance
References
REFERENCES
Available upon request
Languages
Certification
- Licensed Property and Casualty - January 2021
Timeline
Policyholder Service Specialist
OMSNIC & Fortress Insurance Companies
02.2009 - 07.2022
Senior Provider Relations Coordinator
Great West Healthcare
01.2003 - 11.2008
Utilization Review Assistant
One Health Plan of Illinois
01.1999 - 2003
Business Process Specialist
Next Level Solutions
7.11-202 - 05.2023
Associates - Applied Science, Business Administration
Robert Morris College, National Education Center
Diploma -
Carl Schurz High School
- Licensed Property and Casualty - January 2021
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