Martin Gonzales
Oxnard,CA
Summary
Adept at enhancing operational efficiency and customer satisfaction, demonstrated through a proven track record at Anthem Blue Cross. Expertise in HIPAA compliance and claims processing pairs with exceptional problem-solving skills to drive significant improvements in service delivery. Achieved a notable reduction in case backlog, showcasing strong analytical abilities and a commitment to excellence.
Overview
25
25
years of professional experience
Work History
Casual Longshoreman
International Longshore & Warehouse Union
10.2021 - Current
- Increased productivity through effective collaboration with other longshoremen in a fast-paced environment.
- Facilitated smooth sailing for vessels entering or leaving port by securing mooring lines according to established procedures.
- Supported vessel turnaround times by consistently meeting or exceeding established performance metrics for loading and unloading activities.
- Adhered to strict safety regulations while operating heavy machinery, minimizing accidents and injuries on the job site.
- Maintained compliance with local, state, and federal regulations governing port operations, contributing to a safe and efficient work environment for all personnel.
- Reduced delays, ensuring timely movement of cargo to its designated location.
- Streamlined operations with effective communication among team members during loading and unloading processes.
- Loaded and unloaded materials onto and off of trucks for fast shipment.
- Maintained accurate documentation for proper tracking of all cargo movements and storage locations.
Network Service Specialist
Anthem Blue Cross
03.2007 - 03.2022
- Implemented quality control measures that ensured accuracy in case documentation and reduced instances of rework or errors in processing claims.
- Enhanced grievance appeals efficiency by streamlining processes and implementing best practices.
- Provided training and mentorship to new team members, fostering a collaborative work environment focused on continuous improvement.
- Leveraged advanced analytical abilities when evaluating evidence presented in appeal cases, rendering unbiased judgments aligned with organizational policies.
- Reduced case backlog significantly through diligent review and resolution of pending grievances.
- Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
Grievance Appeals Specialist
Anthem Blue Cross
08.2005 - 03.2007
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Responded to customer requests for products, services, and company information.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
Anthem Claims Representative
Anthem Blue Cross
10.1999 - 03.2005
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
Education
High School Diploma -
Hueneme High School
Oxnard, CAAssociate of Arts - General Studies
Ventura College
Ventura, CASkills
- Maritime Regulations Compliance
- Physical Strength
- Cargo loading and unloading
- Heavy Equipment Operation
- Medical terminology knowledge
- Insurance Verification
- Patient confidentiality
- Data entry proficiency
- Claims Processing
- HIPAA Compliance
- Customer Service
- Money Handling
Timeline
Casual Longshoreman
International Longshore & Warehouse Union
10.2021 - Current
Network Service Specialist
Anthem Blue Cross
03.2007 - 03.2022
Grievance Appeals Specialist
Anthem Blue Cross
08.2005 - 03.2007
Anthem Claims Representative
Anthem Blue Cross
10.1999 - 03.2005
High School Diploma -
Hueneme High School
Associate of Arts - General Studies
Ventura College
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