Iyalna Lester
Winter Haven,FL
Summary
An exceptional professional proven successful in leading administrative teams in high-volume settings. Knowledgeable about regulations, managing sensitive files, and producing professional correspondence for diverse needs, while being articulate in communication with a strong work ethic and a natural talent in leadership.
Overview
2
2
years of professional experience
Work History
Claims Coordinator
Sedgwick Claims Management
Winter Haven, FL
11.2023 - Current
- Analyzed and processed complex medical claims by collecting, investigating, and inputting member information via digital data entry systems, contributing to a 95% accuracy rate in supporting adjusters with claim exposure determinations.
- Managed claims through developed action plans to an appropriate and timely resolution, responding to policyholder inquiries, while providing detailed explanations of insurance policies, payments, and claims processes, averaging 300+ claims monthly.
- Maintained expertise in benefits claim processing, insurance principles, medical terminology, and HIPAA regulations, ensuring compliance and increasing claims accuracy by 15%.
- Verified medical records and researched intricate claim issues to provide accurate resolutions and updated information, ensuring favorable outcomes where possible.
- Ensured compliance with legal regulations and company policies during all phases of claims handling, maintaining adherence to applicable procedures and standards.
Fraud Prevention and Detection Specialist
USAA
Lakeland, FL
02.2023 - 12.2023
- Assisted members with a wide range of account transactions, including deposits, withdrawals, PIN resets, transfers, bill payments, and extensively handled inquiries related to fraud, ensuring a high level of accuracy and a 90% member satisfaction rate.
- Collaborated with fraud operations leaders and business partners to support the development and implementation of fraud prevention training initiatives, enhancing team capabilities and fraud detection efforts.
- Led and supported a team in assigned functional areas by overseeing recruiting, development, retention, coaching, and performance management activities, fostering a high-performing and engaged workforce.
- Proactively contacted members to review suspicious account activity, taking decisive action to mitigate risk and protect assets, resulting in a 30% reduction in fraud incidents.
- Ensured risks associated with business activities were effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
Education
High School Diploma -
Sunshine High School
Orlando, FL02-2018
Skills
- Data entry
- Claims
- Database administration
- Customer support
- Account management
- Fraud analysis
- Microsoft Office Suite
- Healthcare
- Documentation
- Investigation
- Software systems
- Banking
- Electronic Health Records (EHR)
- Fraud patterns
- Case management
- Call center operations
Languages
English
Native/ Bilingual
Spanish
Limited
Creole
Limited
References
References available upon request.
Timeline
Claims Coordinator
Sedgwick Claims Management
11.2023 - Current
Fraud Prevention and Detection Specialist
USAA
02.2023 - 12.2023
High School Diploma -
Sunshine High School
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