Ma Estrellita Johara Alfonso
Pittsburgh,PA
Summary
Consummate Claims Associate knowledgeable in insurance coverage, policy terms and conditions. Facilitates claims processing by cultivating productive relationships with stakeholders. Blends analytical and administrative acumen throughout investigations and recommendations. Committed to ensuring customer satisfaction by providing exceptional service and unmatched support. Proficient in utilizing customer service best practices and adept at exploring different solutions to address customer needs effectively.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claim Benefit Specialist
Aetna, a CVS Health
03.2023 - Current
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Followed up with customers on unresolved issues.
- Evaluated and settled complex insurance claims in strict timeframes.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Determined appropriateness of payers to protect organization and minimize risk.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
Dietary Hostess
UPMC Mercy Health Center
08.2022 - 11.2022
- Adheres to department procedures regarding the operation of all food service equipment
- Adheres to hand hygiene and infection control procedures on a consistent basis when interacting with customers
- Assembles and serves meals according to diet orders, menus and patient / guest specific requirements
- Assures the necessary food and service equipment / utensils are secured for assigned area prior to meal service
- Inventories and stocks bulk supplies, following established procedures and designated time frames
- Maintains food safety and quality by applying HACCP principles throughout service
- Patient Service Specific Responsibility: Serves patient meal tray using the designated department script, to include proper patient identification
- Performs sanitation for assigned work area in accordance with departmental procedures and health department guidelines.
Housekeeper
Sunrise Senior Living
08.2016 - 11.2016
- Polished glass surfaces and windows
- Washed, cleaned and disinfected water coolers
- Vacuumed rugs and carpeted areas in offices, lobbies and corridors
- Cleaned and buffed tile floors using industrial cleaning equipment
- Dusted picture frames and wall hangings with a cloth
- Polished all metal hardware fixtures
- Removed waste paper and other trash from the premises to designated area
- Accepted accountability for all assigned building keys, master keys and access cards
- Disinfected and mopped bathrooms to keep them sanitary and clean
- Collected trash and moved garbage cans from kitchen areas to pick-up stations
- Returned emptied garbage receptacles to their proper locations
- Cleaned walls, windows, shades and curtains
- Returned emptied garbage receptacles to their proper locations
- Used chemicals and other cleaning equipment in a proper, safe and responsible manner.
Seasonal Fulfillment Associate
Amazon Sortation Center
11.2016 - 01.2017
- Communicated with dispatchers, warehouses and customers regarding outgoing orders
- Led warehouse improvement initiatives to advance operational efficiencies
- Achieved a 80% on-time shipment rate
- Redirected shipments en route in response to customer requests
- Coordinated with freight forwarders to expedite international shipments
- Loaded products weighing up to 50 pounds onto trailers for delivery
- Processed 80 shipments per 4 hours
- Loaded and unloaded pieces into boxes for shipment
- Maximized sales by shipping on time and accurately
- Moved freight, stock and other materials to and from storage and production areas and loading docks
- Accurately read, understood, and carried out written instructions
- Ensured timely response in picking and packing of reorders
- Followed company procedures to maintain work environment in a neat and orderly condition.
Store Associate
CCAC Bookstore
03.2015 - 10.2015
- Answered questions regarding the store and its merchandise
- Demonstrated use and care of merchandise
- Greeted customers and ascertained customers' needs
- Helped customers with questions, problems and complaints in person and via telephone
- Stocked shelves and supplies and organized displays
- Organized racks and shelves to maintain the visual appeal of the store
- Verified that all customers received receipts for purchases
- Developed positive customer relationships through friendly greetings and excellent service.
Cashier/Price Presentation
Target
04.2013 - 08.2014
- Stocked and replenished merchandise according to store merchandising layouts
- Operated a cash register for cash, check and credit card transactions with 60% accuracy
- Priced merchandise, stocked shelves and took inventory of supplies
- Cleaned and organized the store, including the checkout desk and displays
- Used time efficiently when not serving customers, including folding clothes and cleaning out fitting rooms.
Education
High School Diploma -
Millennium International School
Riyadh, SAAssociate's degree - Dietetic Technician
Community College of Allegheny Main Campus
Pittsburgh, PA07.2024
Certificate - Dietary Manager
Community College of Allegheny County
Pittsburgh, PA12.2023
Skills
- Sales training
- Time management
- Cash register
- Customer service
- Closing
- Data entry proficiency
- Benefits Administration
- Claims Processing
- Policy Interpretation
- Customer Service
- Medical Terminology
Certification
ServSafe Manager, 04/2027, ServSafe Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)-Conference for Food Protection (CFP)
Timeline
Claim Benefit Specialist
Aetna, a CVS Health
03.2023 - Current
Dietary Hostess
UPMC Mercy Health Center
08.2022 - 11.2022
Seasonal Fulfillment Associate
Amazon Sortation Center
11.2016 - 01.2017
Housekeeper
Sunrise Senior Living
08.2016 - 11.2016
Store Associate
CCAC Bookstore
03.2015 - 10.2015
Cashier/Price Presentation
Target
04.2013 - 08.2014
High School Diploma -
Millennium International School
Associate's degree - Dietetic Technician
Community College of Allegheny Main Campus
Certificate - Dietary Manager
Community College of Allegheny County
ServSafe Manager, 04/2027, ServSafe Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANSI)-Conference for Food Protection (CFP)
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