Josephine Soto
Providence,RI
Summary
Experienced professional with a strong background in customer interactions and service solutions. Skilled in conflict resolution, communication, and problem-solving to ensure customer satisfaction and loyalty. Collaborative team player who adapts to changing needs, always focusing on efficient and empathetic service delivery. Known for reliability and proactive commitment to meeting customer and organizational goals.
Overview
20
20
years of professional experience
Work History
Claims Analyst III/Glass Litigation Adjuster
National General an Allstate Company
01.2019 - 01.2025
- Documented files to include all key activities, contacts made, statements taken, including a full outline covering all aspects of the claim and requirements for resolution
- Negotiated settlements with customers, claimants, attorneys and lienholder
- Effectively investigate complex coverage issues and assign to SIU if needed
- Handled all Litigated Glass claims for the state of FL
Member Services Manager
Trinet – Alignment Health Care
01.2015 - 01.2018
- Effectively led a team of 12-15 associates to meet and exceed service expectations. Monitored staff performance and productivity
- Monitored calls to ensure that staff possessed the skills and training necessary to communicate with the plan’s membership, internal and external partners
- Hired, interviewed and trained all staff which included Full Time Employees and Temporary Staff
- Assisted in the implementation of the DVS/Encore call monitoring tool
- Assisted in all member escalations worked directly with staff to ensure timely resolution
- Worked closely with the Appeals and Grievances team and was responsible for all CMS Complaints Tracking Module responses that were categorized as “Service”. Conducted case file reviews and made determinations on Service complaints filed by the plan’s membership
Telesales Operations Supervisor
Humana, Inc.
01.2005 - 01.2014
- Effectively led and inspired a team of 15-18 associates to meet and exceed monthly sales and quality assurance expectations
- Monitored calls to provide ongoing coaching and feedback in order to enhance the contributions, competencies and performance of associates
- Led and coordinated the day-to-day activities of the unit using techniques acquired through Humana’s Leadership Development training
- Managed efficiency to ensure associates met ACW, ATT, and AHT call center metrics
- Hired, interviewed and trained telesales agents
- Conducted ongoing trainings to ensure associates were knowledgeable on updated products/services, processes, and compliance expectations
Education
High School -
Mount Pleasant High School
Providence, RI01.1993
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Florida Metropolitan University
Tampa, FL01.2005
References
Available upon request
Languages
Spanish
Full Professional
Timeline
Claims Analyst III/Glass Litigation Adjuster
National General an Allstate Company
01.2019 - 01.2025
Member Services Manager
Trinet – Alignment Health Care
01.2015 - 01.2018
Telesales Operations Supervisor
Humana, Inc.
01.2005 - 01.2014
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Florida Metropolitan University
High School -
Mount Pleasant High School
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