Daniela Stewart
Houston,TX
Summary
Experienced Healthcare Administration Professional with nearly two decades in patient advocacy and claims processing. Demonstrated proficiency in grievance management, regulatory compliance, and customer service excellence. Adept at navigating Medicare and other complex insurance systems, consistently maintaining high satisfaction levels. Master's in Psychology supports strong analytical and multitasking capabilities.
Overview
17
17
years of professional experience
1
1
Certification
Work History
CRM Analyst
HCSC Through (Temp Agency )
Remote, TX
04.2025 - 06.2025
- Company Overview: Formerly Cigna Medicare Department
- Was transitioned from a Grievances & Appeals to CTM Analyst March 17,2025 . This is when Cigna's Medicare Department transitioned to HCSC
- Processed over 100 claims and grievances, aligning with regulatory and accreditation guidelines to ensure timely resolutions.
- Conducted thorough research to assess claims and appeals, applying contract and regulatory provisions to formulate informed case outcomes.
- Streamlined case tracking and claims workflows, reducing errors by 15% and enhancing processing efficiency.
- Formerly Cigna Medicare Department
- Implemented process improvements that streamlined customer relationship management efforts.
- Conducted regular audits of customer records for compliance and quality assurance.
- Provided technical support for CRM users across multiple departments within the organization.
Grievance & Appeals Coordinator
The Cigna Group Through (Temp Agency )
Remote, TX
12.2024 - 03.2025
- Managed and resolved 200+ Medicare grievances and appeals, achieving a 98% resolution rate by complying with Medicare/CMS regulations.
- Composed clear and detailed letters to patients and healthcare providers, communicating case outcomes and next steps.
- Analyzed claims and grievances, applying regulatory guidelines to categorize and close cases effectively, reducing resolution times by 10%.
- Mentored new hires on grievance management and Medicare regulations, increasing team productivity and adherence to compliance standards.
- Coordinated appeals process for health insurance claims within established guidelines.
- Reviewed and analyzed appeal requests for compliance with company policies.
Customer Service Representative 3 (CSR) Dental Insurance Grievances & Appeals
Humana
Remote
10.2022 - 06.2024
- Company Overview: Work at Home
- Supported dental insurance members with benefit inquiries, claims status, and policy coverage information.
- Researched and resolved complex grievance cases, ensuring timely, accurate, and compliant resolutions in accordance with state and federal regulations.
- Reviewed and processed dental claims, coordinating with providers, internal claims analysts, and quality teams to address discrepancies or escalations.
- Educated members on dental procedures, pre-authorizations, coverage limits, and explanation of benefits (EOB).
- Ensured compliance with HIPAA and internal quality standards while handling high volumes of sensitive health and claims data.
- Documented all member interactions clearly and thoroughly, contributing to accurate record-keeping and performance audits.
- Provided support to new team members and participated in special projects aimed at improving customer experience and reducing call times.
- Work at Home
Customer Service Rep 3 (Medicare Part D)
Elixir/Rite Aid
Remote
07.2021 - 09.2022
- Served as a senior-level representative in a high-volume call center environment, supporting Medicare Part D members with prescription drug plan inquiries.
- Handled complex issues involving claims denials, formulary questions, prior authorizations, and pharmacy network concerns.
- Educated members on plan benefits, Explanation of Benefits (EOB), copayment structures, and coverage stages (deductible, initial coverage, coverage gap, catastrophic).
- Ensured strict compliance with Centers for Medicare & Medicaid Services (CMS) guidelines and HIPAA privacy regulations.
- Trained new hires and provided peer support on call handling, system navigation, and updated procedures.
- Documented all interactions accurately in the system, maintaining quality assurance and resolution standards.
- Assisted pharmacies and providers in claims processing and benefit verification, ensuring timely medication access for members.
CSR - Customer Service Representative
Source point Mortgage/ Cenlar
Remote
10.2020 - 04.2021
- Provided telephone support to borrowers regarding mortgage loan accounts, including payment processing, escrow inquiries, payoff requests, and delinquency assistance.
- Delivered clear and compliant explanations of mortgage terms, escrow analyses, interest rate changes, and repayment options.
- Responded to inquiries about COVID-19 forbearance and hardship assistance programs, helping homeowners navigate available relief options.
- Maintained up-to-date knowledge of CFPB guidelines, investor rules (FHA, VA, Fannie Mae, Freddie Mac), and servicing standards.
- Accurately documented all interactions in CRM systems while maintaining confidentiality and data accuracy.
- Consistently met or exceeded performance goals for call quality, resolution time, and customer satisfaction.
- Resolved escalated issues professionally and collaborated with internal departments to ensure timely follow-up and issue resolution.
Caregiver
FAITH AND CARE HOME HEALTH AGENCY
Hempstead, TX
04.2016 - 10.2020
- Provided compassionate, one-on-one care to elderly clients in their homes, including assistance with bathing, grooming, dressing, toileting, and feeding.
- Monitored and documented clients' health conditions, including changes in physical and emotional wellbeing, and reported findings to nurses or family members.
- Assisted with mobility and transfers using proper lifting techniques and safety protocols.
- Administered medication reminders and followed care plans as outlined by health professionals.
- Performed light housekeeping tasks such as laundry, dishes, and meal preparation, ensuring a clean and organized home environment.
- Supported clients with companionship and engaged them in conversation and daily activities to promote emotional well-being.
- Collaborated with family members, nurses, and other caregivers to coordinate care and ensure continuity.
- Demonstrated excellent time management, empathy, patience, and communication skills.
Remote Customer Service Banker
USAA
Houston, TX
06.2008 - 03.2010
- Delivered outstanding service to USAA members by responding to inquiries regarding checking, savings, credit card, loan, and insurance accounts in a high-volume remote call center environment.
- Assisted members with online banking navigation, password resets, account troubleshooting, and secure transaction support.
- Educated members on USAA products and services, identifying needs and recommending tailored financial solutions to enhance their banking experience.
- Maintained strict compliance with banking regulations and internal policies related to privacy, security, and account verification.
- Resolved billing issues, processed payments, and submitted service requests with a focus on first-contact resolution and member satisfaction.
- Recognized for professionalism, empathy, and ability to de-escalate challenging situations while maintaining a positive tone.
- Utilized multiple systems simultaneously to research and resolve member concerns accurately and efficiently.
Education
M.D. - Psychology
University of Arizona Global Campus
Chandler, AZ09.2025
Bachelor of Arts - Healthcare Administration
University of Arizona
Chandler, AZ09.2023
Skills
- Claims
- Zendesk
- Healthcare Compliance
- EHR systems
- Medical terminology
- Alzheimer's Care
- Resolution letters
- Memory Care
- Cognitive behavioral therapy
- Caregiving
- Dementia Care
- HIPAA
- Hospital Experience
- Hospice Care
- Social Work
- Content management systems
- Banking
- EMR Systems
- Home Care
- Patient Care
- CMR Systems
- Behavioral health
- Certified Healthcare Customer Service Rep
- Facets
- Medication Administration
- Grievances specialist
- Developmental Disabilities Experience
- Medical coding
- Senior Care
- CRM software
- Live chat
- Healthcare management
- Communication skills
- Evernorth
- Claims processing
- CRM implementation
- Grievance resolution
- Quality assurance
- Problem solving
Certification
- CPR Certification
- First Aid Certification
- Adults with Autism
Personal Information
Timeline
CRM Analyst
HCSC Through (Temp Agency )
04.2025 - 06.2025
Grievance & Appeals Coordinator
The Cigna Group Through (Temp Agency )
12.2024 - 03.2025
Customer Service Representative 3 (CSR) Dental Insurance Grievances & Appeals
Humana
10.2022 - 06.2024
Customer Service Rep 3 (Medicare Part D)
Elixir/Rite Aid
07.2021 - 09.2022
CSR - Customer Service Representative
Source point Mortgage/ Cenlar
10.2020 - 04.2021
Caregiver
FAITH AND CARE HOME HEALTH AGENCY
04.2016 - 10.2020
Remote Customer Service Banker
USAA
06.2008 - 03.2010
M.D. - Psychology
University of Arizona Global Campus
Bachelor of Arts - Healthcare Administration
University of Arizona