Emily Saldana
Eldorado
Summary
Efficient professional in insurance claims and policy processing, known for high productivity and the ability to complete tasks with precision. Specialized in analyzing claim details, navigating policy databases, and managing customer communications. Excel in problem-solving, adaptability, and teamwork, leveraging these soft skills to navigate complex situations and achieve positive outcomes.
Overview
20
20
years of professional experience
Work History
Medicaid Appeals Specialist II
HCSC - Blue Cross Blue Shield of Illinois
San Angelo
06.2024 - Current
- Reviewed appeals for compliance with company policies and regulations.
- Coordinated communication between members, providers, and internal departments.
- Advised customers on best practices for submitting complete documentation along with their appeal requests.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Utilized advanced technical skills and expertise to troubleshoot complex problems and implement solutions.
- Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
Benefit Value Advisor
HCSC, Blue Cross Blue Shield
02.2022 - Current
- Explained benefits to plan participants in easy-to-understand terms in order to educate each on available options.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits, and deductions through telephone and email.
- Checked employees' benefits for accuracy through the benefit navigator and RTB.
- Assisted members, providers, and pharmacies with benefits, overrides, preauthorizations, and RX forms through my RX training.
- Trained in Texas and Illinois, lines of business.
- Collaborated with cross-functional teams to enhance member experience and satisfaction.
- Resolved complex client inquiries and claims through effective problem-solving techniques.
- Maintained up-to-date knowledge of healthcare regulations and company offerings.
Rural Mail Carrier
USPS
09.2014 - 02.2022
- Followed safety protocols and regulations while driving, upholding a professional service reputation.
- Delivered mail to rural residents along designated routes.
- Maintained records on customers with mail forwarding and change-of-address requests.
- Organized mail ahead of delivery runs for correct routing.
- Handled accurate cash payments for postage, and incurred fees.
- Resolved complaints calmly and professionally to maintain customer satisfaction.
- Distributed items on time and to correct locations for punctual, professional mail services.
- Trained Rural Carrier Associates on new routes.
Manager
Liberty Tax Service
01.2006 - 01.2009
- Managed and motivated employees to be productive and engaged in their work.
- Accomplished multiple tasks within established timeframes.
- Maintained a professional, organized, and safe environment for employees and patrons.
- Resolved staff member conflicts, actively listening to concerns, and finding appropriate middle ground.
- Cross-trained existing employees to maximize team agility and performance.
- Maximized performance by monitoring daily activities and mentoring team members.
- Onboarded new employees with training and new-hire documentation.
- Managed tax preparation processes for diverse client needs and complex tax situations.
- Supervised staff training on tax regulations and software usage to enhance service delivery.
- Coordinated client appointments and ensured efficient workflow during peak tax season.
Education
Associate of Science - Accounting And Business Management
Howard College
San Angelo, TX05.2002
High School Diploma -
Wall High School
Wall, TX05.2000
Skills
- RX Cross Trained
- Appeal process management
- Data analysis
- Claims resolution
- Regulatory compliance
- Customer relationship management
- Documentation verification
- Conflict resolution
- Team building
- Problem solving
- Effective communication
- Time management
- Employee training
- Continuous learning mindset
- Strong analytical skills
- Problem-solving capacity
- HIPAA compliance
- Organizational growth
- Multi-tasking
- Detail orientation
Skills
- LGBTQ Cross Trained
- Trained in Medicaid Policies
- Trained in Pharmacy Lines
- Trained in Texas and Illinois
Languages
Spanish
Timeline
Medicaid Appeals Specialist II
HCSC - Blue Cross Blue Shield of Illinois
06.2024 - Current
Benefit Value Advisor
HCSC, Blue Cross Blue Shield
02.2022 - Current
Rural Mail Carrier
USPS
09.2014 - 02.2022
Manager
Liberty Tax Service
01.2006 - 01.2009
Associate of Science - Accounting And Business Management
Howard College
High School Diploma -
Wall High School