Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Hi, I’m
LIZETT VIVES
Los Angeles,CA
Summary
Overview
12
years of professional experience
Work History
L.A Care Health PlanLos Angeles, California
Member Services Representative III
01.2011 - 12.2013
Job overview
- Research and verify member eligibility through state website and internal system for plan partners, providers and members
- Answer general program and administration questions
- Effectively managed high-volume of inbound member calls, over 100 calls per day.
- Triage of calls to appropriate unit for further assistance
- Work with member relations specialists to assist members with complex issues and coordination of care issues within plan partners
- Participate and coordinate interpretation/translation services for members
- Good understanding of service for disadvantaged population, seniors, or people with chronic conditions or disabilities
- Review pre-service authorizations, concurrent and post-service medical necessity; benefit coverage appeals and reconsiderations, and complex provider claim disputes.
Health NetWoodland Hills, California
State Health Program Advocate
10.2009 - 07.2010
Job overview
- Researched claims according to established policies and procedures
- Determined claim status, able to communicate member benefits, reimbursement policies, and coding guidelines and company policy to all members and providers
- Interpret Health Net remittance advices, member Explanation of Benefits claims and Coordination of benefits
- Handled ACD calls for members and providers with eligibility, benefit and research questions
- Communicated accurate information on questions and requests
- Handled difficult and sensitive issues with the highest level of customer confidentiality
- Developed and maintained comprehensive knowledge of all Health Net policies and procedures servicing departmental process of state health programs
- Met department standards for quality, productivity and teamwork
- Participated in various training and information functions that were available to enhance skills, improve performance and contribute to ongoing achievement of department goals.
Anthem Blue CrossNewbury Park, California
Member Claims Associate
01.2008 - 03.2009
Job overview
- Performed research and analysis on claims and benefits
- Resolved issues for members, providers, group administrators and brokers
- Analyzed situations case by case to resolve issues and perform necessary research in a full and complete manner
- Performed audit on policies to ensure claims are paid or denied based on terms of contract
- Enforced contract terms according to claims payments, while addressing benefit and provider status and impact on the company
- Received claim requests from members and providers via telephone calls, mail, fax and electronically.
IndyMac BankPasadena, California
Research Specialist
12.2003 - 10.2007
Job overview
- Monitored incoming requests and delegate research materials to appropriate departments
- Regular use of financial analysis using standardized and industry specific templates and formulas with Microsoft Excel
- Processed invoices, analyzed disbursements and payments to and from clients
- Used customer service experience to resolve issues, reviewed resolution of complaints, analysis of client payments
- Resolved of conflicts and issues that arise from customer or company discrepancies
- Processed high volumes of monies coming in through different means (wires, online payments, checks) on a daily basis
- Developed step by step tools for training new hires.
- Monitored research data to assess accuracy, validity, and integrity.
- Developed evaluation plans for formative and summative program evaluations.
IndyMac BankPasadena, CA
Clerk Specialist
08.2000 - 12.2003
Job overview
- Posted and deposited funds according to guidelines
- Verification of documents for completion and accuracy, file and report maintenance of client information
- Responsible for mail and files ordered using FAST program; tasks included receipt, review, logging and shipment of mail.
- Provided quality clerical support through data entry, document management, email correspondence and overseeing operation of office equipment.
Education
Pasadena Community CollegePasadena
A.A from Liberal Studies
07.2014
University Overview
- Professional development completed in Medical Terminology
Insurance & Securities School of CaliforniaLos Angeles
Ethics & Code
04.2010
University Overview
- Completed professional development in 12 hour CA Ethics & Code Course 40 hour CA Life Agent Course
Pasadena High SchoolPasadena, CA
High School Diploma
05.2000
University Overview
- Member of Student Business Achievement Program
Blair High SchoolPasadena
Regional Occupational Program
05.2000
University Overview
- Professional development completed in Modern Office Technology
- Professional development completed in Introduction to Web Design
Skills
- Bilingual in English and Spanish
- Strong analytical, coaching/mentoring skills, team building
- Proficient in Microsoft Word, Excel, Outlook, Power Point
- Proficient in Peoplesoft, WebExtender, File Net and Lotus Notes Proficient in RightFax, UPS Shipping and Wells Fargo Commercial Services: software and hardware
- Computer literate and Internet savvy
- Accurate typing-65 wpm/10-key
- Multitasking and Organization
- Efficient and Detail-Oriented
Timeline
Member Services Representative III
L.A Care Health Plan
01.2011 - 12.2013
State Health Program Advocate
Health Net
10.2009 - 07.2010
Member Claims Associate
Anthem Blue Cross
01.2008 - 03.2009
Research Specialist
IndyMac Bank
12.2003 - 10.2007
Clerk Specialist
IndyMac Bank
08.2000 - 12.2003
Pasadena Community College
A.A from Liberal Studies
Insurance & Securities School of California
Ethics & Code
Pasadena High School
High School Diploma
Blair High School
Regional Occupational Program
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