Maribel Nevarez
Glendale,AZ
Summary
Experienced professional specializing in business development solutions for healthcare and business sectors. Proven ability to analyze operational and compliance trends, aligning customer expectations with business objectives. Skilled in designing events that address challenges and enhance competitive advantage.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Producer Help Desk/Process Improvement Analyst
United Healthcare
Tempe, AZ
06.2021 - Current
- Collaborated with cross-functional partners to enhance processes, improving accuracy and efficiency by over 20%.
- Collected and analyzed trends from multiple systems, presenting actionable solutions that resulted in improved daily operations.
- Engaged with senior management, executed special projects, including pilots, training programs, and process enhancements with cross-functional teams, which demonstrated strong leadership.
- Coached, trained, and supported new hires on various subjects and resource utilization, which increased compliance, quality, and efficiency by more than 30%.
- Presented innovative ideas for both employee engagement activities and process improvements, which successfully resulted in employee retention while implementing key initiatives.
Provider Relations and Claims Examiner
BlueCross Blue Shield of Arizona
Phoenix, AZ
12.2016 - 10.2019
- Served as a liaison between healthcare providers and internal departments to resolve claims, payments, and policy inquiries in accordance with plan-specific guidelines, which resulted in reducing appeals from consumers by 11%.
- Accurately reviewed and adjudicated medical claims using codes (CPT, ICD-10, and HCPCS), ensuring compliance and reimbursement, which resulted in improved provider network relations and stakeholder satisfaction.
- Conducted and investigated provider disputes and appeals, recommending resolution strategies, and issuing determinations that reduced the improper submission of claims by 13%.
- Conducted provider support and provider education on billing requirements, claims submission processes, and policy changes that reduce errors and denials by more than 15%.
Benefits Enrollment Specialist
HealthPlan One (HPONE)
Phoenix, AZ
08.2016 - 12.2016
- Served as a liaison between beneficiaries and telesales agents, delivering product information and managing and coordinating appointment scheduling.
- Collaborated with partners to enroll clients in Medicare Advantage Plans, providing market analyses.
- Reviewed all reports on site availability, compliance, and data reconciliation.
- Provided exceptional customer service while managing administrative functions.
- Oversaw customer relations by efficiently addressing inquiries and matching needs with program products.
Education
Bachelor of Arts - Information Security
Arizona State University
Tempe, AZ12-2020
Minor - Sustainability Studies
Arizona State University
Tempe, AZ12-2020
Associate of Arts - Business Administration
Phoenix Community College
Phoenix, AZ05-2019
Skills
- Data collection and trend analysis
- Cross-functional collaboration
- Policy and procedure development and enhancement
- Process documentation and training
- Cross-functional stakeholder engagement
- Quality assessment and compliance optimization
- Process performance coaching and mentoring
- Compliance and conflict resolution management
- Microsoft Office proficiency
Accomplishments
Guided Principles Award, UHC, 2022
Professional Development
Member and Vice President of Public Relations, Toastmasters International, La Voz De Oro Toastmasters
Languages
Spanish
Native/ Bilingual
Certification
Accident and Health or Sickness Life
References
References available upon request.
Timeline
Producer Help Desk/Process Improvement Analyst
United Healthcare
06.2021 - Current
Provider Relations and Claims Examiner
BlueCross Blue Shield of Arizona
12.2016 - 10.2019
Benefits Enrollment Specialist
HealthPlan One (HPONE)
08.2016 - 12.2016
Bachelor of Arts - Information Security
Arizona State University
Minor - Sustainability Studies
Arizona State University
Associate of Arts - Business Administration
Phoenix Community College