ISABELLA QUINONEZ
Garden City,KS
Summary
Detail-oriented Claims Specialist with over 5 years of experience in data entry, claims processing, and fraud investigation. Proven ability to adjudicate complex claims, apply policy guidelines, ensure regulatory compliance, and provide outstanding customer service. Seeking to leverage expertise in claims analysis and process improvement in a fast-paced healthcare environment.
Overview
8
8
years of professional experience
Work History
Fraud Specialist
Advance Call Center Technologies
01.2020 - 12.2024
- Investigated and resolved complex fraud claims, ensuring accurate documentation and reporting for legal and regulatory compliance.
- Analyzed suspicious activity patterns and conducted in-depth investigations to identify potential fraudulent transactions, resulting in a significant reduction in fraud-related losses.
- Processed high volumes of data entry for claims and case management, maintaining meticulous records and ensuring data accuracy and integrity.
- Provided exceptional customer service to affected individuals, clearly communicating the status and outcome of investigations and offering guidance on preventive measures.
- Collaborated with cross-functional teams including legal, risk management, and compliance departments, to develop and implement effective fraud prevention strategies.
- Reviewed and verified customer information to detect anomalies and prevent unauthorized access to sensitive account details.
- Conducted training sessions for team members on fraud detection techniques and best practices, enhancing the team's overall efficiency and effectiveness.
- Utilized advanced software tools for data analysis and reporting, enabling the timely identification and response to fraudulent activities.
- Maintained detailed records to support appeal and reconsideration processes.
Data Entry Clerk
IHop
01.2017 - 01.2020
- Collaborated with other departments to resolve issues regarding incorrect data entries.
- Maintained confidentiality of sensitive information entered into the system.
- Verified accuracy and completeness of data entry into the database system.
- Handled cash payments and reconciled daily transactions accurately.
- Resolved any customer complaints or issues quickly and professionally.
- Ensured compliance with health and safety regulations at all times.
- Generated reports on discrepancies between physical counts and computer records.
- Inputted data into computer system to ensure accuracy and completeness of records.
- Entered large volumes of data quickly with a high degree of accuracy.
Customer Resolution Coordinator/Data Entry Specialist
Six Flags National Call Center
01.2017 - 08.2018
- Managed and resolved customer claims efficiently, ensuring timely and satisfactory resolutions while maintaining a high level of customer satisfaction.
- Processed and entered large volumes of data related to customer claims, maintaining accuracy and attention to detail in all records.
- Analyzed claim details to identify trends and patterns, contributing to process improvements and enhanced customer service.
- Coordinated with various departments to gather necessary information for claims resolution, facilitating effective communication and collaboration.
- Maintained up-to-date records of all customer interactions and claims, ensuring compliance with company policies and regulatory requirements.
- Developed and implemented data entry procedures to streamline operations and reduce errors, resulting in increased efficiency and accuracy.
- Provided regular reports on claims and data entry metrics, offering insights and recommendations to management for strategic decision-making.
- Trained new team members on data entry protocols and best practices, fostering a culture of accuracy and efficiency within the team.
Education
Diploma -
Dodge City High School
Skills
- Claims Processing
- Data accuracy
- Invoice Processing
- Quality Assurance
- Customer Service-Oriented
- Multitasking and Organization
- Registration and Admissions
- Customer Service
- Documentation and Reporting
- Problem Resolution
- Complaint Handling
- CRM Software
- Inbound and Outbound Calling
- Account updating
- Information Security
- Complaint resolution
- Data Collection
- Call Management
- De-Escalation Techniques
- Meticulous attention to detail
- Maintains confidentiality
- Filing and data archiving
- Verifying data accuracy
- Document Preparation
- Database Administration
- Team Collaboration
- Dispute Mediation
- Claims Review
- Settlement determinations
- Compliance Management
- Documentation Review
- Claims Investigation
- Data Processing
- File Management
- Database Management
- Conflict Resolution
- Claims adjudication
- Eligibility verification
- Multitasking Abilities
Accomplishments
Processed over 200 claims per week with 98% accuracy, exceeding departmental QA benchmarks.”
“Handled sensitive claimant concerns with empathy and clarity, resulting in a 4.9/5 average customer rating.”
“Identified and resolved over $50,000 in overpayments through detailed review and auditing of claims.”
“Reduced processing errors by 30% through consistent adherence to coverage and eligibility guidelines.”
Timeline
Fraud Specialist
Advance Call Center Technologies
01.2020 - 12.2024
Data Entry Clerk
IHop
01.2017 - 01.2020
Customer Resolution Coordinator/Data Entry Specialist
Six Flags National Call Center
01.2017 - 08.2018
Diploma -
Dodge City High School
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