EVELYN C. VICENS-DIAZ
Fishers,IN
Summary
Analytical problem-solver with excellent communication skills. Well-versed in insurance policies, practices and standards with over 6 years of Insurance Claims experience. Effective at interviewing claimants, compiling records and documenting findings. Solid abilities in developing objectives and strategies to settle medical claims.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Investigation Support Coordinator
COVANCE/LABCORP
04.2021 - Current
- Notifying Investigator Sites, sponsors, and affiliates of laboratory results, exclusion flags, and test cancellations as defined in Statement of Work.
- Maintaining global communication and coordination regarding service definitions/changes for global processes.
- Documenting all service failures, resolve and escalate to management when appropriate resolution is incomplete
- Worked with other departmental staff to answer questions and resolve problems.
Claims Analyst
SEVEN CORNERS, INC
Carmel, IN
06.2017 - 08.2020
- Investigate, evaluate and determine benefit coverage on daily incoming claims using multiple systems and tools in a timely and accurate matter
- Deny claims or rescind policies when required based on contractual definitions, limitations and exclusions
- Analyze coverage and claims to avoid fraudulent activity and ensure claim validity and accuracy
- Communicate and work with inter/intra departments
- Perform claims adjudication with exposure to Coordination of Benefits (COB) and/or interpretation of Explanation of Benefits (EOB).
- Directed claims negotiations within allowable limit of $150,000.00 and supported successful litigations for advanced issues.
Claims Adjuster
CNO FINANCIAL
Carmel, IN
02.2014 - 06.2017
- Responsible for providing claim service in a manner that promotes integrity and customer satisfaction
- Examined claims forms and other records to determine insurance coverage.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Directed claims negotiations within allowable limit of $100,000.00 and supported successful litigations for advanced issues.
Senior Policyholder Services Representative/ Policyholder Services
CNO FINANCIAL
Carmel, IN
04.2011 - 02.2014
- Providing impeccable customer service while professionally answering inbound phone calls from policyholders nationwide and Spanish speaking policyholders
- Managing daily work queues and escalating unresolved problems as needed.
- Streamlined service processes for quicker response times, leading to improved customer experiences.
- Collaborated with team members to ensure seamless communication and consistent service delivery.
- Developed strong relationships with clients, fostering trust and loyalty through exceptional service provision.
Education
MBA - Industrial Management
Interamerican University of Puerto Rico
San German, PR05.1995
Bachelor of Arts - Business Administration
Interamerican University of Puerto Rico
San German, PR05.1990
Skills
- Proficient in Microsoft Office 2021, including Microsoft Outlook, and Microsoft Excel
- Advanced Experience in Microsoft Power Point
- Basic Experience in Microsoft One Note
- Salesforce and Workday applications experience
- Fully Bilingual (Spanish-English)
Certification
Associate Life Management Institute (ALMI), Associate Customer Service (ACS),
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Investigation Support Coordinator
COVANCE/LABCORP
04.2021 - Current
Claims Analyst
SEVEN CORNERS, INC
06.2017 - 08.2020
Claims Adjuster
CNO FINANCIAL
02.2014 - 06.2017
Senior Policyholder Services Representative/ Policyholder Services
CNO FINANCIAL
04.2011 - 02.2014
MBA - Industrial Management
Interamerican University of Puerto Rico
Bachelor of Arts - Business Administration
Interamerican University of Puerto Rico