Kathy Alfaro
Summary
To seek and maintain full-time remote position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
5
5
years of professional experience
Work History
Claims Specialist
TEK System
Remote
05.2023 - 09.2023
- Responsible for quality control test of applicant eligibility determinations based on the program requirements
- Assessing eligibility requirements based on ERAP policies and procedure
- Communicating with claimants and employers by phone to obtain missing information process and policy standards are followed to meet program compliance requirements
- Identify and discuss issues and proposed solutions with leadership
- Monitor and maintain applicant electronic files through progression of file lifecycle
- Effectively communicate identified compliance issues and corrective actions to analysts, elevate training needs as needed
- Apply critical thinking and problem solving to complete applicant files
- Analyze claim information to determine the cause of outstanding issues and determine next steps to resolve these issues
- Document issues at hand, along with actions taken to supplement case notes
- Evaluate data for potential eligibility issues
- Reviewed cases for payment approvals and appeals
- Referring more complex issues to supervisor for review
- Demonstrating the ability to make timeline and logical decisions
- Notating all contacts and actions taken on a claim clearly and thoroughly
- Ability to work independently in remote environment, seeking and helping when needed.
Claims Specialist
Aston Carter
Remote
09.2021 - 03.2023
- Review unemployment insurance claim data provided by claimants and employers
- Analyze claim information to determine the cause of outstanding issues and determine next steps to resolve these issues
- Document claimant and employer interactions, along with actions taken to supplement case notes
- Evaluate unemployment insurance claims data for potential eligibility issues
- Reviewed claims for weekly benefit amounts and payments
- Reviewed employer protests of unemployment claims for potential eligibility issues
- Determine protest status and process claims with confirmed eligibility issues for potential adjudication and determination by the California Employment Development Department
- Accessing the information again against the requirement based on UI code policies and procedures
- Sending employers standard forms to obtain additional information and clear up discrepancies
- Worked closely with subject-matter experts to gain understanding and identify Fraud Waste and Abuse cases
- Reviewing wage and income information payment and cross-matching to determine the ability if payments were made appropriately
- Demonstrating the ability to make logical decisions.
Office Tech II
California Correctional Board of Supervisor Org.
Escalon, Ca
10.2018 - 02.2021
- Support the office manager in reviewing and verifying legal compliance documents
- Update and maintain membership database and develop reports as requested by the manager
- Collect data, track members’ statistics, and prepare reports
- Assigned, logged tracked and referred cases to labor relations attorneys
- Scheduled monthly meetings for state board members and directors
- Managed data entry for new applicants’ membership and withdrawals
- Submitted member’s application to various union offices
- Responsible for retiree cancellations and approvals with CALPERS
- Submitted employee wage deductions code to the state controller’s office
- Responsible for booking hotel and car reservation for members
- Performed or assisted other miscellaneous duties as assigned by the membership manager and executive director.
Education
Diploma -
McAteer High School
Skills
- Computer Literacy
- Claims Resolution
- Critical Thinking
- Research Skills
- Problem Solving
- Data Entry
- Strategic Thinking
- Auditing
- Analytical Skills
- Emergency Dispatch
- ICD9- Coder
- Customer Service
- Information Verification
- Data Entry Software
- Claims Processing
- Microsoft Office
- Policy Review
- SharePoint
- Smartsheets
- Office 365
- Microsoft Teams
- NICE/IEX
- InContact Virtual Contact Center
- Fieldglass
- Multiple systems logins utilizing different multi-factor authentication applications
- 3270 HHSDC Session/DOS-based systems
Professional References
- Dianna Jordan, Maximus Supervisor, Diof11@gmail.com, (860) 337-1647
- Heather Muheim, CA Rent Relief Program, Lead, Heather.Muheim@ca-rentrelief.com, 213-302-6536
Personal Information
Title: Claims Specialist Candidate
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Timeline
Claims Specialist
TEK System
05.2023 - 09.2023
Claims Specialist
Aston Carter
09.2021 - 03.2023
Office Tech II
California Correctional Board of Supervisor Org.
10.2018 - 02.2021
Diploma -
McAteer High School
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