Results-oriented Claims Adjuster bringing hands-on law enforcement experience and exceptional leadership and communication skills. Background includes criminal investigation, insurance fraud and surveillance.
Overview
10
10
years of professional experience
Work History
Claim Analyst
Health Net
04.2022 - Current
Interacted with clients and employees, which helped cultivate positive working relationships.
Viewed reports regularly to make sure processing was conducted efficiently.
Identified key areas not performing well and implemented effective, new processes.
Documented information gathered in field and uploaded data to company database for efficient processing using symphony .
Identified suspicious losses and contacted manager for investigative assistance.
Corrected facility codes to properly classify medicalclaims.
Support Staff & Server
Sauced BBQ & Spirits
01.2019 - Current
Upsold high-profit items to enhance sales numbers.
Explained menu items and suggested appropriate options for food allergy concerns.
Used slow periods to restock supplies, ice, trays, and delivery bags.
Learned and followed local alcohol laws to keep restaurant compliant with regulations.
Resolved customer complaints promptly and professionally to maintain positive reputation.
Accountant and Billing Services
Walmart Supercenter
03.2017 - 01.2018
Completed daily cash functions like account tracking, payroll and wage allocations, budgeting, donating, and cash, and banking reconciliations.
Reconciled accounts and reviewed expense data, net worth, and assets.
Documented cash, credit, fixed assets, accrued expenses, and line of credit transactions.
Partnered with auditors to track errors and add contributions to maintain accuracy.
Maintained up-to-date knowledge on professional accounting standards to manage financial recordkeeping.
Used accounting software to issue tax returns and prepare consolidated reports.
Customer Service Supervisor (Front of House)
Walmart Supercenter
01.2015 - 03.2017
Actively supported service associates by quickly responding to questions via phone and email and finding appropriate solutions to customer issues.
Monitored metrics and developed actionable insights to improve efficiency and performance.
Coached team members to deliver hospitable, professional service while adhering to set service models.
Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
Created customer support strategies to increase customer retention.
Responded to customer inquiries and resolved complaints to establish trust and increase satisfaction.
Education
A.A. in Billing and Coding -
Asher college
01.2022
A.A. in English -
Fresno City College
Fresno, CA
01.2017
Roosevelt High School
01.2014
Skills
Skilled in multiple softwares
Proficient in billing and coding
Dispute tracking
Claims analysis
File and Record Management
Awards
Employee of the Month, Sauced BBQ & Spirits, 08/01/19, This title is awarded to employees who execute their jobs with integrity and a high level of competency. In addition, those who receive this title consistently bring a positive attitude and adaptability to the workplace.
Senior Appeals and Grievances Coordinator-Expedited (EXR) Team at Health NetSenior Appeals and Grievances Coordinator-Expedited (EXR) Team at Health Net