Ligia Torres
Rome,NY
Summary
Driven MetLife Dental Approver II with a proven track record in enhancing claim denial resolution and fostering patient satisfaction. Excelled in optimizing workflows and training staff, leveraging strengths in problem-solving and bilingual communication. Demonstrated expertise in claims evaluation and customer support, ensuring compliance and efficiency in high-pressure environments. Focused Translator with highly developed understanding of Spanish language and culture. Skilled in quickly and accurately translating written documents and audio recordings. Over 15 years of related expertise.
Overview
25
25
years of professional experience
Work History
Overnight Stocker
Walmart
07.2016 - 01.2021
- Maintained proper storage of overstock items, keeping backroom areas organized and accessible for future use.
- Removed all boxes and related trash from sales floor and processed through compactors.
- Enhanced store appearance for better customer experience through meticulous shelf stocking and arrangement.
- Used dollies and pallet jacks to unload and organize merchandise from delivery trucks.
MetlLife Dental Approver II
MetLife
10.1995 - 06.2010
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Optimized workflows within the team by assigning tasks based on individual strengths and expertise in particular payers or denial reasons.
- Maintained up-to-date knowledge of industry trends and best practices in denial management, ensuring the organization''s processes remained competitive and effective.
- Trained new employees on denial management best practices, fostering a knowledgeable and efficient workforce.
- Assisted patients in understanding their coverage limitations or non-covered services, promoting transparency and patient satisfaction during the billing process.
- Reduced aging accounts receivable balance with timely appeal submissions for denied claims.
- Collaborated with billing department staff to ensure accurate coding and charge entry, minimizing future claim denials.
- Ensured compliance with industry regulations and guidelines during denial management activities, avoiding potential legal issues or penalties.
Education
Property & Casualty Course -
Mohawk Community College
Rome, NY12.1999
High School Diploma -
Santaluces Community High School
Lantana, FL05.1988
Skills
- Fluent Bilingualism
- Problem-Solving
- Spanish translation
- Customer Support
- Call center experience
- Payment Processing
- Document Translation
- Call Center Operations
- Refund Processing
- Claims Evaluation
- Database Research
- Spanish Fluency
- Teamwork and Collaboration
- Customer Service
- Computer Skills
- Data Entry
- Problem Resolution
- Translation and Interpretation Services
- Microsoft Office
- Understanding Customer Needs
- Calm Under Pressure
- Work Prioritization
- Calm and Professional Under Pressure
- Issue and Complaint Resolution
- Customer Relations
- Multi-line phone talent
- Professional telephone demeanor
- MS Office
- Money handling abilities
- Remote Office Availability
- Call Documentation
- Relationship Building
- Customer Data Confidentiality
- Document and Records Management
- Administrative and Office Support
- 80 wpm Typing Speed
- Product Knowledge
- De-Escalation Techniques
- Policies and Procedures Adherence
Accomplishments
- Achieved Result by completing Task with accuracy and efficiency.
Languages
Spanish
Native or Bilingual
Timeline
Overnight Stocker
Walmart
07.2016 - 01.2021
MetlLife Dental Approver II
MetLife
10.1995 - 06.2010
Property & Casualty Course -
Mohawk Community College
High School Diploma -
Santaluces Community High School