MARIA E AGUAYO
Cedar Rapids,Iowa
Summary
Dedicated to enhancing company operations with an analytical and disciplined approach. Able to work with minimal direction to solve problems, resolve conflicts and respond to customer inquiries.
Overview
17
17
years of professional experience
1
1
Language
Work History
Senior Disability Claims Examiner
Sedgwick Claims Management Services Inc.
Cedar Rapids, IA
08.2018 - Current
- Provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due
- Making timely payments/approvals and adjustments, medically managing disability claims
- Coordinating investigative efforts, thoroughly reviewing contested claims, negotiating return to work with or without job accommodations
- Evaluating and arranging appropriate referral of claims to outside vendors
Annuity Claims Examiner
TRANSAMERICA
Cedar Rapids, IA
07.2015 - 08.2018
- Prepare insurance claim forms or related documents and review them for completeness.
- Manage the review of a claim and the outside sources used in the review.
- Thoroughly document correspondence and conversations, correspond verbally and in writing with claimants, medical providers, medical examiners, and law enforcement, Work closely with manager claims examiner, legal counsel, medical director, claims assistants and other departments, Monitor claims for fraud and proceeds accordingly, communicates the company's position regarding the claim.
- Maintains compliance with regulations and respond to any insurance department complaints.
Quality Analyst
09.2012 - 06.2015
- Analyze and evaluate inbound calls to Transamerica to make sure that the customer is treated with respect, offering great service and provided accurate information and follow company guidelines.
- Review clients requests that are received in writing such as beneficiary changes or ownership changes to make sure company policy is followed and educate the employees as to processed that need to be followed.
- Encourage a growth and praise the employee for a job well done.
- Prepare presentations to educate new team members regarding the importance of quality and great customer service.
Customer Service Representative
03.2007 - 09.2012
- I worked directly with customers taking inbound calls and customers requests and information regarding their policy.
- Educated customers as to how their policy works developed great relationships with Spanish - Speaking agents as they prefer to be helped in their native language.
- Have used my bilingual skills to assist the company with the interpretation of documents for claims, marketing, title, billing and compliance.
- Have achieved a current skill set for Cedar Rapids agent and agent/complex calls.
- Helped Transamerica with a project to keep clients on the books with questions in relation to their policies linked to National Bond and Trust and the Savings bonds.
- Have mentored new hires during their first weeks on the phones and followed up with any questions they have on procedures.
Education
Completed coursework towards Liberal Arts - undefined
KIRKWOOD COMMUNITY COLLEGE
Mar 2006
High School Diploma - undefined
COLUMBUS COMMUNITY HIGH SCHOOL
May 1994
Skills
- Microsoft Word, Excel, Outlook and Power Point
- Read, write and speak English and Spanish
- Great Customer Service Skills
- Analytical
- Team player
- Flexibility
- Great Communication Skills
- Conflict Resolution
- Get along great with others, respectful, good job ethic
- Attention to detail
Timeline
Senior Disability Claims Examiner
Sedgwick Claims Management Services Inc.
08.2018 - Current
Annuity Claims Examiner
TRANSAMERICA
07.2015 - 08.2018
Quality Analyst
09.2012 - 06.2015
Customer Service Representative
03.2007 - 09.2012
Completed coursework towards Liberal Arts - undefined
KIRKWOOD COMMUNITY COLLEGE
High School Diploma - undefined
COLUMBUS COMMUNITY HIGH SCHOOL
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