Karla Alejandra Guzman Pedroza

• Taking both Spanish and English calls for member and providers
• Assisting providers office with claim/tar details
• Assisting members with the status of the claims
• Scheduling members with appointments to dr offices
• Creating letters and documents for members

Clinical Screening Coordinator — Project (8 Months)

• Facilitate the clinical screening process by arranging provider second-opinion evaluations for treatment authorization review
• Collect, verify, and assemble medical and dental documentation, including authorization forms and diagnostic imaging
• Prepare and deliver organized case packets to reviewing providers to support evidence-based determinations
• Serve as a primary point of contact between members, providers, and internal teams
• Schedule and confirm appointments, ensuring timely access to care and adherence to review timelines
• Monitor case progress and follow up as needed to prevent delays in clinical review

• Taking bother Spanish and English calls
• Helping providers get information on benefits and contracts.
• Helping customers with vision benefits and finding providers and other inquiries
• Processing ups claims
• Correcting claims

• Admitting information for doctors for verification or approval
• Typing 200 words per min
• Processing ups claims
• Correcting claims

• Taking bother Spanish and English calls
• Assisting supervisor with new hires
• Helping providers get information on benefits and contracts.
• Helping customers with vision benefits and finding providers and other inquiries

• Setting up appointments for customers to get their vehicles donated to charities and sell to auction houses.
• Organizing our filing system.
• Making cold calls to the members that have
• Submitted applications and never finished them.

• Created different solutions to do tasks.
• Handled cash deposits DT.
• Made sure inventory was always on point.
• Achieved monthly quotas.
• Obtained referrals and leads from other families.