Jaclyn Colunga
Pflugerville,TX
Summary
To obtain a position as Leasing Consultant
Experienced with eligibility determination, client assessment, and regulatory compliance. Utilizes advanced problem-solving skills to handle complex cases efficiently. Track record of effective communication and collaborative teamwork in high-pressure situations.
Overview
12
12
years of professional experience
Work History
Eligibility Specialist
Continental General
09.2023 - Current
- Enhanced client satisfaction by providing timely and accurate eligibility determination for various assistance programs.
- Reduced errors in eligibility determinations by maintaining thorough knowledge of program guidelines and regulations.
- Provided exceptional customer service through prompt response times, clear communication channels, and diligent follow-up practices.
- Ensured compliance with local, state, and federal regulations during all phases of the eligibility determination process.
- Resolved discrepancies with client applications to verify eligibility.
- Maintained detailed records of client interactions, ensuring accuracy and confidentiality of sensitive information.
- Processed and certified documents for accuracy and compliance with government regulations.
Claims Examiner
Continental General
03.2022 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Implementation Specialist
Boon Chapman
12.2019 - 12.2021
- Company Overview: Third party administration of Medical benefits
- Prepares, reviews, and processes applications and other forms for completeness and accuracy, in accordance with carrier administration guidelines.
- Set up new groups, plan builds, request external plan codes, build rates.
- Handles follow-up communications with account managers to get needed Information.
- Establishes and maintains effective communication with account managers and other departments either by phone or correspondence.
- Ensures positive customer experiences, both externally and internally.
Social Media Process Review
Social Media Company
08.2017 - 12.2019
- Review non-objectionable content, create tasks, follow-up on open tickets, etc.
- Help improve search quality. Investigate and rate search results
- Evaluate, label and identify patterns in search results and provide feedback
- General data entry related tasks
- Provide suggestions to improve the process and workflow.
- Attention to detail is essential to ensure the quality of work execution
- Able to work in multiple tools/web browser windows at one time
- Familiar with MS office (mainly excel) for updating progress
- Good search and navigating skills, Knowledge of pop culture, and Interpersonal Skills
Individual Policy Clerk
Boon Chapman
02.2014 - 08.2017
- Company Overview: Third party administration of Medical benefits
- Prepares, reviews, and processes applications and other forms for completeness and accuracy, in accordance with carrier administration guidelines.
- Assists with timely ID card and packet fulfillment.
- Handles follow-up communications with agents and applicants to get needed information.
- Establishes and maintains effective communication with clients, members and other departments either by phone or correspondence.
- Ensures positive customer experiences, both externally and internally.
- Serves as back-up to any team function, as directed by manager.
- RX and Home Health Care claims examiner
- Assisted Broker Team to meet certain goals.
Senior Customer Service Advocate
Sears Holdings Corporation
09.2013 - 02.2014
- Familiar with tools and approaches in organizational training and development.
- Excellent client satisfaction experience and team management knowledge.
- Effective written and verbal communication skills on a daily basis.
- Diffusing escalated customer calls by displaying problem solving skills.
- Leads by example and positive role model.
- Providing a safe working environment by ensuring company safety compliance guidelines.
Skills
- Excellent customer satisfaction
- Time management skills
- Promptness and dependability
- Telephone etiquette
- Documentation and reporting
- Policy interpretation
- Application review
- Eligibility procedures
- Fraud investigation
Timeline
Eligibility Specialist
Continental General
09.2023 - Current
Claims Examiner
Continental General
03.2022 - Current
Implementation Specialist
Boon Chapman
12.2019 - 12.2021
Social Media Process Review
Social Media Company
08.2017 - 12.2019
Individual Policy Clerk
Boon Chapman
02.2014 - 08.2017
Senior Customer Service Advocate
Sears Holdings Corporation
09.2013 - 02.2014
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