Damaris Nieves
Haines City
Summary
Accomplished Claims Examiner with a proven track record at Sedgwick Claims Management, showcasing expertise in claims processing and exceptional verbal communication. Leveraged computer skills and claims investigation to enhance efficiency, notably reducing claim processing time. Demonstrated leadership in cross-functional teams, achieving significant improvements in customer service and operational workflows.
Overview
20
20
years of professional experience
Work History
Claims Examiner
Sedgwick Claims Management
12.2022 - 01.2025
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Researched claims and incident information to deliver solutions and resolve problems.
- Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
- Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
Leave of Absence Coordinator
Sedgwick Claims Management
09.2022 - 12.2022
- Developed training materials related to company policies surrounding leaves of absence, ensuring employees and managers were well-informed of their rights and responsibilities.
- Collaborated with medical professionals to verify documentation supporting employee leave requests, maintaining strict confidentiality at all times.
- Minimized instances of unscheduled absences by offering guidance and resources to employees seeking alternative solutions prior to requesting formal leaves of absence.
- Maintained up-to-date knowledge on changes to state and federal leave regulations, proactively updating company policies in response to shifting legal requirements.
- Managed the administration of short-term and long-term disability benefits, coordinating with insurance providers to ensure timely processing of claims.
Service Center Representative
Sedgwick Claims Management
11.2020 - 09.2022
- Maintained detailed records of customer interactions, ensuring accurate documentation for future reference or follow-up actions.
- Enhanced customer satisfaction by providing timely and accurate information on products and services.
- Contributed to the achievement of team goals through consistent personal performance metrics surpassing objectives.
- Reduced call escalations with effective communication skills and thorough understanding of company policies.
- Exceeded departmental standards for average handle time while maintaining high levels of quality assurance ratings consistently throughout tenure at the service center.
- Utilized multiple software applications simultaneously for efficient data entry and record-keeping purposes during calls.
- Managed high call volumes while maintaining professional demeanor and strong attention to detail.
In-Room Dining Supervisor
Gaylord Palms Resort & Convention Center
10.2018 - 03.2020
- Promoted upselling techniques among team members to increase revenue without compromising guest experience.
- Maintained a clean and organized work environment, adhering to strict hygiene standards and regulations.
- Conducted regular inventory checks, ensuring adequate stock levels for seamless service delivery.
- Improved communication between front desk, housekeeping, and kitchen staff for seamless order fulfillment and guest relations.
- Implemented quality control measures to maintain consistency in food preparation, presentation, and delivery.
- Ensured compliance with local health codes by conducting regular inspections of the in-room dining area and equipment.
- Managed budget for in-room dining department, carefully monitoring expenses while maintaining quality standards.
- Enhanced guest satisfaction by ensuring timely delivery of in-room dining orders and maintaining high-quality presentation.
- Maintained responsibility for food, beverage and kitchen equipment ordering, regularly assessing departmental needs and verifying sufficient stock levels.
- Coordinated high-quality dining services to meet or exceed guest expectations, enforcing quality standards and facilitating smooth operations.
In-Room Dining Order Taker
Gaylord Palms Resort & Convention Center
02.2012 - 10.2018
- Managed multiple telephone lines simultaneously, ensuring timely response to all incoming calls from guests.
- Assisted management with inventory control measures by providing accurate information regarding stock levels and product usage trends.
- Supported the development of promotional materials for in-room dining offerings, generating increased interest among guests.
- Upheld brand standards consistently throughout daily tasks and interactions with both guests and colleagues.
- Provided exceptional customer service by promptly addressing issues or concerns raised by guests during their dining experience.
- Maintained a high level of accuracy while inputting orders into the system, reducing errors and miscommunications.
- Collaborated with culinary team to ensure special requests were met, leading to higher guest satisfaction rates.
Hostess
Gaylord Palms Resort & Convention Center
11.2007 - 02.2012
- Answered customer questions about hours, seating, and menu information.
- Greeted customers warmly upon arrival and provided friendly and warm presence throughout dining experience.
- Demonstrated strong multitasking skills, balancing responsibilities such as answering phone calls, greeting guests, and updating reservation logs simultaneously.
- Took reservations and to-go orders by phone, answered customer questions, and informed of accurate wait times.
Lead Cashier
Panera Bread
05.2005 - 10.2007
- Maintained a balanced cash drawer with diligent attention to detail and accurate counting practices.
- Trained, mentored, and developed new cashiers with positive and encouraging techniques to maximize performance and team contributions.
- Assisted customers by answering questions and fulfilling requests.
- Processed both cash and card purchases and returns.
- Enhanced customer satisfaction by providing efficient and accurate cash transactions.
Education
High School Diploma -
Poinciana High School
Kissimmee, FL05.2005
Skills
- Claims processing
- Verbal communication
- Data verification
- Disability claims process
- Computer skills
- Claims investigation
Languages
Spanish
Native or Bilingual
Timeline
Claims Examiner
Sedgwick Claims Management
12.2022 - 01.2025
Leave of Absence Coordinator
Sedgwick Claims Management
09.2022 - 12.2022
Service Center Representative
Sedgwick Claims Management
11.2020 - 09.2022
In-Room Dining Supervisor
Gaylord Palms Resort & Convention Center
10.2018 - 03.2020
In-Room Dining Order Taker
Gaylord Palms Resort & Convention Center
02.2012 - 10.2018
Hostess
Gaylord Palms Resort & Convention Center
11.2007 - 02.2012
Lead Cashier
Panera Bread
05.2005 - 10.2007
High School Diploma -
Poinciana High School
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