Summary
Overview
Work History
Education
Skills
Languages
References
Work Availability
Work Preference
Interests
Software
Quote
Timeline
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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

7
7
years of professional experience

Work History

Claims Support Coordinator

Sedgwick Claims Management
Winter Haven, FL
11.2023 - 11.2024
  • 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 (TTEC)
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, FL
02-2018

Skills

  • Data entry
  • Claims management
  • Technical troubleshooting
  • Customer service
  • Account management
  • Fraud analysis
  • Microsoft Office Suite
  • Healthcare
  • Documentation
  • Workflow optimization
  • Cross-functional collaboration
  • Banking software
  • Electronic Health Records
  • Risk assessment
  • Medical terminology
  • Multi-line phone systems

Languages

English
Native/ Bilingual
Spanish
Limited
Creole
Limited

References

References available upon request.

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference

Work Type

Full Time

Work Location

Remote

Important To Me

Career advancementCompany CultureWork-life balance

Interests

Healthcare

Banking

Administration

Customer Service

Revenue Cycle

Technical Support

Software

Juris

Genesys

Kronos

IDComm

Microsoft Office

Citrix

Workday

Google Suite

Quote

There’s no shortage of remarkable ideas, what’s missing is the will to execute them.
Seth Godin

Timeline

Claims Support Coordinator

Sedgwick Claims Management
11.2023 - 11.2024

Fraud Prevention and Detection Specialist

USAA (TTEC)
02.2023 - 12.2023

High School Diploma -

Sunshine High School

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Iyalna Lester