Jesus Diaz
Hudson,FL
Summary
Dedicated Senior Appeals Coordinator with a proven track record of effectively managing appeals processes to optimize outcomes and ensure compliance with regulatory requirements. Adept at streamlining operations, and delivering exceptional results. Committed to upholding the highest standards of ethics and quality in all professional endeavors. Ready to drive process improvements, mitigate risks, and uphold client satisfaction in a senior leadership role.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Senior Appeals Representative
UnitedHealth Group
02.2017 - Current
This experience demonstrates my expertise in appeals management, regulatory compliance, process improvement, and the ability to achieve favorable outcomes in complex healthcare appeals cases:
- Researched and resolved written complaints submitted by consumers and physicians or providers.
- Completed documentation of final appeals determination using appropriate templates.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Acted as a backup subject matter expert during peak workload periods, ensuring the seamless continuation of appeals expertise and maintaining excellent case resolution rates.
Data Analytics Development Program
UnitedHealth Group
08.2022 - 08.2023
This data analytics development experience showcases my practical skills in data development, my contribution to data quality and efficiency, and my ability to work effectively within a team to deliver tangible results in a professional setting.
- Completed data cleaning and data validation of existing spreadsheets to promote robust data management platform, resulting in accurate data analysis and entry.
- Successfully completed coursework related to the program, reinforcing theoretical knowledge with practical application in data collection, transformation, and analysis.
- Collaborated on data visualization projects, creating interactive dashboards and reports using tools like Power BI.
- Identified, analyzed, and interpreted trends or patterns in complex data sets by finding correlations and visualizing with charts.
Research Interviewer / Survey Writer
Nielsen Media Research
04.2012 - 09.2015
This experience underscores my expertise in crafting effective research surveys and interview scripts, as well as my ability to adapt to different research methodologies and contribute to data-driven decision-making processes.
- Maintained confidentiality of customer information and company procedures.
- Maintained patience and professionalism despite negative customer interactions.
- Recorded customer survey answers verbatim to achieve 100% accurate reporting.
- Performed in-depth interviews with research subjects and compiled data and analyses into reports for review by group leader.
Education
B.AS Technology Development And Management - Information Security Assurance and Data Analytics
St. Petersburg College
Clearwater, FL12.2016
Skills
- Business Intelligence
- Relational Databases
- Billing Codes
- Appeals Support
- HIPAA Regulations
- Medicare Compliance
- Administrative Support
- Meeting Deadlines
- Report Creation
- Multitasking Abilities
- Teamwork and Collaboration
- Critical Thinking
Certification
- Countryside High School National Honor Society - magna cum laude
- St. Petersburg College - Associate Degree in General Education (GEN-AA)
- St. Petersburg College - Information Technology (IT) Security Certificate
- National Healthcare Association - Successfully completed the requirements set forth by the N.H.A as a Certified Billing and Coding Specialist (CBCS)
Timeline
Data Analytics Development Program
UnitedHealth Group
08.2022 - 08.2023
Senior Appeals Representative
UnitedHealth Group
02.2017 - Current
Research Interviewer / Survey Writer
Nielsen Media Research
04.2012 - 09.2015
B.AS Technology Development And Management - Information Security Assurance and Data Analytics
St. Petersburg College