Gina Rivera
Davenport,FL
Summary
Professional with strong background in claims management, prepared to make significant impact. Skilled in assessing and processing claims accurately, resolving complex issues, and ensuring customer satisfaction. Effective team collaborator with focus on achieving results and adapting to changing needs. Known for analytical thinking, communication skills, and attention to detail.
Overview
18
18
years of professional experience
Work History
Claims Representative
Progressive
11.2023 - Current
- Assisting customers with reporting accident losses: This includes gathering information about the accident, the vehicle damage, and any injuries.
- Educating customers about their coverage and options: Explaining policy details, deductibles, and available benefits.
- Guiding customers through the claims process: Helping them understand each step, from initial reporting to resolution.
- Resolving claims: Working with customers and other parties to determine liability, assess damages, and arrange for repairs or payments.
- Providing support and empathy: Understanding the stressful situation customers are in and offering reassurance and guidance.
- Maintaining accurate records: Documenting all interactions and claim details in the company's systems
Medical Billing and Coding Capstone (100-Hour Senior Project)
Florida Technical College
- 04.2019
- Abstract information from medical records and assign standard codes using CPT and ICD-10-CM.
- Simulation experience on in and out patient coding procedures for all areas of CPT Manual.
- Analyzed patient health records to identify principal or first listed and secondary diagnoses.
- Demonstrate the ability to assign Diagnosis Related Groups (DRGs).
- Simulation experience on billing for any durable medical supplies using HCPCS Manual.
District Manager
Cricket Wireless
09.2009 - 12.2016
- Surged sales, service, employee productivity, and customer satisfaction rates across fifteen retail location while building a culture focused on the mission and values of the organization. Administered HR policies/practices, architected/implemented workflow process and performance improvements, and protected company assets.
- Interviewed, hired, coach, and trained candidates and employees
- Designed more attractive merchandise presentation strategies and special marketing campaigns, resulting in increased store traffic and profits.
- Heightened productivity in all areas of business; 400% in traffic volume, 250% in accessory sale, and 350% in overall profit within 60 days period.
- Conducted daily, weekly conference calls/monthly Managers meeting; and performance reviews for each location.
- Set store’s quotas for Activation, Accessory sales, Feature Attachments, and profitable revenue.
- Monitored and deposit daily cashflow
Pharmacy Care Tech
Walgreens Customer Care Call Center
05.2007 - 08.2009
- Entered new patients’ profiles and prescription into medication input software system
- Communicated directly with insurance and doctor’s office via telephone, fax, and email
- Answered and a screen phone calls for staff pharmacist in friendly, efficient manner
- Efficiently answered multi-line phone and process high volume of order request from nurse, doctors, and pharmacist
- Accurately received and verify prescriptions
- Send refill of prescriptions to pharmacy via computer
- Resolved inbound and outbound calls from customers insurance denial
- Maintain a high-volume workload within a fast pace environment. Assisted an average of 550 clients in any given week consistently meting benchmarks in all areas
- Managed the escalated service concern received from customers
- Maintained expectation regarding call quality and time resolution
Education
Medical Billing and Coding Specialist -
Florida Technical College
Kissimmee, Florida04.2019
Medical Assistant Certification - undefined
Everest University
Orlando, Florida09.2008
Bachelor of Science - BUSINESS ENTREPRENEURSHIP MANAGEMENT AND MARKETIN
Florida Technical College
Kissimmee, FL07-2022
Skills
- CPT Coding
- HCPCS Coding
- Medicare, Medicaid, & TRICARE
- Health Insurance Verification
- Front Desk/Receptionist Duties
- Time management
- Claims processing
- Attention to detail
- Customer service
- Critical thinking
- Active listening
- Documentation processing
Awards
Medical Assistant Honor Roll Graduate 2009 (Everest University)
Languages
Spanish
Native or Bilingual
Timeline
Claims Representative
Progressive
11.2023 - Current
District Manager
Cricket Wireless
09.2009 - 12.2016
Pharmacy Care Tech
Walgreens Customer Care Call Center
05.2007 - 08.2009
Medical Billing and Coding Capstone (100-Hour Senior Project)
Florida Technical College
- 04.2019
Medical Assistant Certification - undefined
Everest University
Medical Billing and Coding Specialist -
Florida Technical College
Bachelor of Science - BUSINESS ENTREPRENEURSHIP MANAGEMENT AND MARKETIN
Florida Technical College
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