Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Elizabeth Cordero

Houston,TX

Summary

Applying for the role of Claims specialist with the aim of using my experience in the insurance industry to provide excellent services while ensuring accuracy in claims processing.

Overview

15
15
years of professional experience

Work History

Senior Claims Representative

UnitedHealthcare,
03.2016 - Current
  • Senior Claims Representative-Currently work with a national team. Handle Inbound calls from different sectors in United Healthcare. Primary duties are to inspect and Adjust claims correctly according to a member’s benefit plan. Educate Members on how claims get processed and why they have been denied and how it correlates to their plan. Guide members as to what their next course of action will be. Provider outreaches, if there is an error in coding, medical records are requested or there is a discrepancy in prior authorization/appeals. Coordinate Benefits and update Primary and Secondary Insurance. Facilitate with any eligibility issues, either getting their HR involved or Cobra Carrier.Received frequent compliments and high NPS, Survey scores, for going above and beyond my duties.
  • Test Kitchen Advocate-front line employee, worked on Pilots, which were eventually rolled out unto the production floor. Our Recent Pilots consisted of member outreaches for Pharmacy Prior Authorization Denials and Welcome Calls. On the Pharmacy PA Denials Pilot we proactively reach out to members regarding RX Prior Authorization Denials and inform members what their options are following a denial. We also do Welcome calls, where we reach out to Members and provided them with a complete overview of their plan, and a better understanding of how their plan works and any incentives or programs that are offered. With welcome calls we set the tone for the member, we want to build a long-lasting relationship with them and want them to have the best healthcare experience possible. I also Part of Social Responsibility, where I, with other team member put our ideas together as to how to make a difference in our local community. Recently, We have collaborated to raise funds for Military Families, raise awareness for Autism and work with local schools to raise funds for children who are unable to pay for school lunch.
  • Customer Service Advocate-Trained to handle different Platforms of United Healthcare, (Prime and UNET.) Facilitated Provider outreaches with the member, to schedule appointments or to request any pending information (for claim purposes, Prior Authorizations, Pharmacy, CPT codes). Educated member about their benefits. .Collaborated with cross-functional teams to address complex customer issues and improve overall experience.Responded to customer requests for products, services, and company information.Followed up with customers about resolved issues to maintain high standards of customer service. Investigated and resolved customer inquiries and complaints quickly.Trained staff on operating procedures and company services.Sought ways to improve processes and services provided.Improved customer satisfaction by providing timely and accurate information on claim status and resolution.

Server

BJ’s Restaurant and Brew house
08.2015 - 10.2016
  • Guided guests through menus while demonstrating knowledge of the food, beverages and ingredients. Provided friendly and attentive services. Inventoried and Restocked items through the day. Assertively upsold alcoholic beverages, appetizers, and desserts. Moved and arranged tables, chairs and place settings and organized seating for groups with special needs. Effectively listened to understand and clarified guest concerns and issues. Monitored guest for intoxication and immediately reported concerns to management. Assisted in cashiering and Point of Sale system procedures during busy hours.

Server

Rainforest Café
05.2010 - 08.2015
  • Consistently Provided professional, friendly and engaging service. Displayed enthusiasm, and knowledge about the restaurant’s menu and products. Routinely supported other areas of the restaurant as requested, including answering telephones and completing financial transactions for other staff. Set dining tables according to type of even and service standards. Addressed diner complaints with kitchen staff and served replacement menu item promptly. Maintained positive working relationships with others to reach business Goals

Education

High School Diploma -

Bellaire High School
05.2007

Associates of Art - Education

Houston Community College
05.2025

Skills

  • Call center experience
  • Data entry
  • Administrative support
  • Data collection
  • Live chat support
  • Professional telephone demeanor
  • Process optimization
  • Fluent in multiple languages
  • Creative problem solving
  • Member support
  • Inbound and outbound calling
  • De-escalation techniques

Languages

Spanish
Native or Bilingual

Timeline

Senior Claims Representative

UnitedHealthcare,
03.2016 - Current

Server

BJ’s Restaurant and Brew house
08.2015 - 10.2016

Server

Rainforest Café
05.2010 - 08.2015

Associates of Art - Education

Houston Community College

High School Diploma -

Bellaire High School

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Elizabeth Cordero