David A. Pino

Organized and maintained accurate records of field operations and personnel.

• Communicated with providers to assess needs and coordinate services for members, ensuring appropriate support.
• Built and managed relationships with contracted providers to address needs, issues, and concerns through in-person visits, telephone, and email.
• Analyzed data from various sources to identify trends and patterns, informing improvements in service delivery.
• Maintain and update databases of provider information
• Create reports of provider information to report to oversight entity
• Completed trainings for providers
• Assist providers coming into and leaving the network
• Accurately documented all relevant information into the system for record-keeping.

• Assisted customers with policy inquiries and claims processing.
• Resolved customer issues through clear communication and targeted problem-solving.
• Utilized company software for tracking claims and updating customer information.
• Educated clients on insurance products and coverage options available.
• Collaborated with team members to enhance service delivery strategies.
• Handled escalated complaints with professionalism and empathy towards customers.
• Enhanced customer satisfaction by providing knowledgeable and friendly service while resolving issues.
• Conducted field inspections to verify vehicle specifications.
• Evaluated vehicle conditions to determine fair market values.
• Utilized appraisal software for accurate valuation processes.
• Maintained client communication throughout appraisal process to ensure timely updates on progress.
• Completed accounts receivables from repair shops and processed check payments.

• Accurately processed large volume of medical claims every shift.
• Processed claims using proprietary software tools and systems.
• Analyzed claim information for accuracy prior to submission.
• Verified coding accuracy on medical bills, ensuring compliance with insurance regulations to facilitate timely claims processing.
• Reviewed patient records, confirming insurance coverage and eligibility to streamline approval processes.
• Investigated and resolved denied or rejected claims, achieving resolution in a timely manner to minimize delays in reimbursement.
• Resolved claim discrepancies through thorough investigation and analysis.
• Communicated with medical providers to gather necessary documentation.
• Ensured compliance with industry regulations and company policies.
• Maintained detailed records of claims activities for audit purposes.
• Maintained detailed records of all activities related to claims processing.
• Interpreted policy language to determine coverage levels for each claim submitted.
• Participated in meetings with internal staff members and external vendors.
• Assisted customers with inquiries about the status of their claims via telephone or email.
• Sent clinical requests and missing information letters to obtain incomplete information.
• Inputted data into the system, maintaining accuracy of provider coding information and reported services.
• Examined claims, records and procedures to grant approval of coverage.
• Prepared and reviewed insurance-claim forms and related documents for completeness.
• Coordinated and planned investigations of claims to confirm compensability and coverage.
• Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.

• Conducted financial assessments to recommend suitable banking products.
• Helped customers open and close accounts, apply for loans and make sound financial decisions.
• Assisted customers with deposits, withdrawals, transfers, loan payments and other banking transactions.
• Resolved customer issues efficiently to maintain satisfaction and loyalty.
• Assisted clients with account management and financial service inquiries.
• Educated customers on a variety of retail products and digital solutions, enhancing customer experience.
• Educated customers on digital banking tools, enhancing convenience and user experience.
• Built strong rapport with new and existing clients to better serve financial needs and promote branch loyalty.
• Identified potential fraud risks on accounts, safeguarding client assets and maintaining trust.
• Described promotional offers and utilized persuasive sales techniques to upsell services, increasing client engagement and branch revenue.
• Balanced cash drawer daily and reconciled discrepancies.