Daina Castillo
Placentia,CA
Summary
Dynamic Senior Claims Quality Representative at Optum RX with a goal-oriented mindset and strong analytical skills. Proven track record in reducing errors through comprehensive audits and trend analysis. Exceptional communicator and collaborator, consistently exceeding quality metrics while enhancing operational efficiency. Committed to continuous improvement and delivering outstanding results in fast-paced environments.
Overview
11
11
years of professional experience
Work History
Senior Claims Quality / Audit Representative
Optum RX
11.2021 - Current
- Provide support by reviewing, researching investigating and auditing problematic claims
- Analyze and identify trends to provide feedback and reports to reduce errors and improve claims processes and performances
- Reviewed claim data for pricing, eligibility, formulary coverage, prior authorizations, and coding accuracy.
- Maintained detailed audit documentation while safeguarding confidential member and provider information
- Collaborated with operations, training and leadership teams to support continuous quality improvement.
- Met and exceeded quality, productivity, and turnaround time metrics in a fast-paced environment
- Conducted comprehensive financial audits ensuring compliance with regulatory standards.
- Prepared detailed audit reports summarizing findings and recommendations for management review.
Customer Service Representative
OptumRx
04.2017 - 11.2021
- Worked effectively in fast-paced environments.
- Resolved customer inquiries efficiently, enhancing overall satisfaction rates.
- Managed high-volume calls daily, maintaining service quality and professionalism.
- Developed and maintained comprehensive documentation for internal processes and protocols.
- Handled escalated calls professionally, effectively resolving complex issues and ensuring client satisfaction at all times.
- Mastered multiple software systems for seamless navigation during calls, improving efficiency and reducing hold times for customers.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries in a timely manner.
- Reduced average call handling time, ensuring prompt service to customers while maintaining quality interactions.
- Maintained detailed records of customer interactions, streamlining communication efforts between various departments.
Sales Agent
Discount Ticket & Tours
08.2014 - 04.2017
- Developed and maintained client relationships to drive sales growth.
- Conducted market research to identify new sales opportunities and trends.
- Implemented strategic sales initiatives to enhance customer engagement.
- Trained and mentored junior sales staff on best practices and techniques.
- Developed strong relationships with clients through excellent customer service and regular followups.
- Assisted call-in customers with questions and orders.
- Boosted referral rates by cultivating positive relationships with satisfied customers who were eager to recommend our products/services to others.
Education
High School Diploma -
La Habra Highschool
La Habra, CASkills
- Goal-oriented mindset
- Organizational skills
- Problem-solving
- Analytical thinking
- Excellent communication
- Multitasking
- Teamwork and collaboration
- Attention to detail
- Time management
Timeline
Senior Claims Quality / Audit Representative
Optum RX
11.2021 - Current
Customer Service Representative
OptumRx
04.2017 - 11.2021
Sales Agent
Discount Ticket & Tours
08.2014 - 04.2017
High School Diploma -
La Habra Highschool