Maria Angeles Saltijeral
Aurora,IL
Summary
Resourceful professional with extensive experience in claims operations and customer service. Proven leadership in managing teams across various locations, enhancing client relationships through adaptability and effective communication. Expertise in contract analysis, appeals investigations, and financial services drives productivity and satisfaction in dynamic environments.
Overview
32
32
years of professional experience
Work History
Caregiver - In-Home Assistance
European Services LLC
Aurora, USA
08.2023 - Current
- Ensured client well-being and comfort while fostering trusting relationships.
- Maintained accurate care documentation to support seamless communication among care team and families.
- Utilized adaptability and problem-solving skills to meet evolving client needs.
- Prepared meals in accordance with dietary criteria and provided personal care for daily living tasks.
- Assisted with mobility and organized household environments to enhance client independence.
Owner/Operator
I of the Angeles LLC
Aurora, USA
06.2019 - Current
- Launched and operated retail store in downtown Aurora, managing sales and wellness services.
- Oversaw daily operations to ensure a positive shopping experience.
- Managed inventory levels through effective ordering and restocking of products.
- Developed and implemented marketing strategies to attract customers effectively.
- Monitored sales performance and analyzed financial reports for over 12 local artisans and small businesses.
Claims Operations Specialist-Claims Operations
MultiPlan
Naperville, USA
08.2011 - 02.2018
- Directed and supervised claims departments in Naperville and Rosemont, ensuring compliance with auditing standards.
- Recovered network contracted claims through meticulous research of provider data, enhancing salvage rates.
- Verified and interpreted coded and uncoded medical billing data to accurately apply negotiated contracts.
- Monitored team performance and workflow to maintain established productivity and quality standards.
Customer Service Representative II
Contact Center Fulfillment
03.2010 - 08.2011
- Determined need for re-pricing by aligning contracted providers' fee schedules with contract provisions to ensure accurate claim processing.
- Verified appeal and claim data by securing necessary documentation to support upper departmental staff on re-pricing corrections.
- Facilitated claim resolution by forwarding copies of contracts and fee schedules upon request.
Senior Claims Examiner
Hallmark, BlueCross BlueShield
Naperville, Illinois
11.2002 - 06.2009
- Addressed daily inquiries from members and providers about benefits and claims, ensuring timely, accurate responses.
- Managed claim appeals and investigations for Illinois and New Mexico business to support compliance and resolution.
- Trained and supervised New Mexico line of business, maintaining accreditation for investigations and appeals while enhancing productivity.
- Investigated grievances and appeals, determining policy guidelines and gathering necessary information, including Department of Insurance inquiries for IL and NM.
Assistant Manager
American General Finance
07.1994 - 07.2002
- Supervised and coordinated activities of workers collecting overdue payments for lines of credit, increasing collection effectiveness
- Analyzed financial status and property evaluations to determine feasibility of credit, ensuring sound lending decisions
- Recommended approval of customer applications for personal loans and mortgages, contributing to revenue growth
- Reviewed collection resources and consumer quality field calls to enhance time management
Education
High School Diploma -
Aurora Central Catholic
Aurora IL05-1991
Skills
- Client relationship management
- Team supervision
- Customer relationship management
- Collections management
- Financial analysis
- Analytical thinking
- Inventory control
- Marketing strategy
- Claims processing
Languages
English
Professional
Spanish
Professional
Timeline
Caregiver - In-Home Assistance
European Services LLC
08.2023 - Current
Owner/Operator
I of the Angeles LLC
06.2019 - Current
Claims Operations Specialist-Claims Operations
MultiPlan
08.2011 - 02.2018
Customer Service Representative II
Contact Center Fulfillment
03.2010 - 08.2011
Senior Claims Examiner
Hallmark, BlueCross BlueShield
11.2002 - 06.2009
Assistant Manager
American General Finance
07.1994 - 07.2002
High School Diploma -
Aurora Central Catholic