IRENE DOROTHY H. MACIAS
Las Vegas,NV
Summary
Experienced and dedicated Administrative/Customer Service Professional with perseverance, exceptional interpersonal and critical thinking skills seeking long term career opportunity.
Overview
7
7
years of professional experience
Work History
GRIEVANCE & APPEALS ANALYST I
ANTHEM, INC.
Las Vegas, NV
11.2018 - 10.2019
- Review provider complaints
- Coordinate with appropriate internal departments to resolve provider complaints related to authorizations and/or plan
- Verify provider complaints are processed in system in a timely manner and within required contractual guidelines
- Manage written correspondence during provider complaint process to provide updates regarding complaint
- Process production of 50-60 appeals daily
AT HOME PRIOR AUTHORIZATION REPRESENTATIVE
ALORICA/EXPRESS SCRIPTS, INC
Cedar, KS
12.2017 - 11.2018
- Effectively manage high-volume of inbound and outbound calls in a home office environment
- Provide accurate and appropriate information in response to customer inquiries via phone call and/or fax
- Demonstrate mastery of customer service call script within specified time frame
- Verify patient date and billing information
- Confirm prior authorization request for prescription fill/refill
- Calculate dosing and FDA regulations for dosing information and maximum daily availability per patient's prescription plan
- Review insurance policy to determine patient's coverage
- Meet 96% accuracy rate on call audits
- Obtain handle time a maximum of 5 minutes per call
GLOBAL ORDER ADMINISTRATOR II
IGT, INC.
Las Vegas, NV
01.2017 - 09.2017
- Process quotes and parts orders for assigned regions
- Enter requests into SAP and support the configuration of orders
- Communicate with customers worldwide to support any inquiries on quotes and order status
- Analyze parts needed for game conversion orders and determine jurisdictions and compliance regulations
- Resolve order holds due to finance, compliance or licensing reasons to complete order
- Determine priority of orders to be processed
- Verify purchase values for compliance
- Calculate freight and discount amounts for domestic and international shipments
- Meet requirement of processed orders of 25 per day and accuracy of 96%
SERVICE SUPPORT SPECIALIST
TCS JOHN HUXLEY AMERICAS
Las Vegas, NV
04.2015 - 02.2016
- Process quotes, orders, RMA and/or transfer consignment for materials for both domestic and/or international requests
- Coordinate and perform activities such as order entry, order acknowledgement, order revision and preparation of some shipping documents
- Review tickets in Salesforce for accurate billing information
- Conduct customer follow up on service related issues
- Coordinate with Business Development Managers to produce complete and accurate quotes by verifying pricing and terms to ensure compliance with company policy and gaming compliance
- Schedule service and maintenance visits to customer sites
CONTRACT ORDER PROCESSOR
MANAGED STAFFING/VARIAN, INC.
Dallas , TX
04.2013 - 11.2014
- Process orders, RMA and/or transfer consignment for materials for both domestic and/or international requests via email
- Coordinate and perform activities such as order entry, order acknowledgement, order revision and preparation of some shipping documents
- Review backlog report from Order Processing System and take corrective action
- Meet daily production requirement of 50 processed orders
Education
Associate of Applied Science - Computer Business Administration
Heald College School of Business
San Jose, CA10.1999
Skills
- Microsoft Office Suite
- Citrix Operating System
- Avaya Softphone
- C360 Application
- Salesforce
- SAP Application
- Peachtree Accounting
- Quickbooks (Basic)
- Adobe Acrobat
- Internet / Market Research
- Bilingual (English/Tagalog)
- Typing 50 WPM
Timeline
GRIEVANCE & APPEALS ANALYST I
ANTHEM, INC.
11.2018 - 10.2019
AT HOME PRIOR AUTHORIZATION REPRESENTATIVE
ALORICA/EXPRESS SCRIPTS, INC
12.2017 - 11.2018
GLOBAL ORDER ADMINISTRATOR II
IGT, INC.
01.2017 - 09.2017
SERVICE SUPPORT SPECIALIST
TCS JOHN HUXLEY AMERICAS
04.2015 - 02.2016
CONTRACT ORDER PROCESSOR
MANAGED STAFFING/VARIAN, INC.
04.2013 - 11.2014
Associate of Applied Science - Computer Business Administration
Heald College School of Business
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