Melissa Alonzo
Hale Center
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
11
11
years of professional experience
Work History
Appeals Analyst
Experian Health
11.2016 - 02.2024
- Improved the efficiency of the appeals process by reviewing and analyzing claim denials and discrepancies.
- Developed strong relationships with providers, fostering open communication channels for more efficient resolution of claim disputes.
- Maintained detailed records and organized documentation to facilitate smooth appeals processing, ensuring all relevant information was readily available for review.
- Negotiated settlements successfully with external parties involved in claim disputes while maintaining professional demeanor at all times.
- Analyzed and rendered determinations on assigned non-complex grievance and appeal issues.
- Evaluated internal policies and procedures regularly to identify areas for improvement in the overall appeals process.
- Followed department guidelines and tools to conduct reviews.
- Enhanced customer satisfaction with timely resolution of appeals, addressing concerns thoroughly and professionally.
- Navigated regulatory requirements proficiently, adhering to state and federal guidelines throughout the appeals process.
- Leveraged data analysis tools to track performance metrics, identifying trends in case outcomes that informed strategic decision-making efforts.
- Utilized guidelines and review tools to conduct extensive research and analyze grievance and appeal issues.
- Communicated complex information clearly to stakeholders, presenting findings and recommendations to guide decision-making processes.
- Streamlined workflows for faster decision-making, evaluating medical records and other documentation to support appeals decisions.
- Managed a high volume of cases, prioritizing tasks effectively and meeting strict deadlines for appeals resolutions.
- Collaborated with interdisciplinary teams to ensure accurate claims adjudication, reducing errors and inconsistencies in the review process.
- Examined claims forms and other records to determine insurance coverage.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Researched claims and incident information to deliver solutions and resolve problems.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Conducted thorough research on industry trends, staying informed on best practices for effective appeals management.
- Reviewed, analyzed and processed non-complex grievances and appeals.
- Identified suspicious losses and contacted manager for investigative assistance.
- Maintained suspicious claims database and prepared reports for supervisors.
- Handled calls from customers and other stakeholders about processes.
- Prepared documents for managers or legal personnel.
Office Credit Collections Clerk II
Medtronic
08.2013 - 11.2016
- Provided ongoing training to junior staff members on best practices in credit collections, enhancing overall team performance.
- Coordinated closely with legal counsel when necessary to navigate complex cases involving litigation or bankruptcy proceedings.
- Enhanced customer satisfaction by promptly addressing inquiries and resolving disputes regarding payment terms.
- Streamlined communication channels between departments, fostering a collaborative environment for effective credit management strategies.
- Achieved higher recovery rates by developing customized payment solutions tailored to individual client needs.
- Analyzed historical data to identify trends in payment behavior, informing targeted collection efforts for high-risk accounts.
- Supported accounting department by reconciling outstanding balances and providing timely updates on collections progress.
- Established strong relationships with key clients through consistent communication and professional demeanor, promoting long-term business partnerships.
- Conducted thorough investigations of disputed claims, ensuring fair resolution for both parties involved.
- Maintained accurate records of all collections activities, ensuring compliance with company policies and industry regulations.
- Maintained strict adherence to ethical standards and regulatory guidelines, ensuring professional and compliant collections practices.
- Implemented more efficient invoicing procedures, reducing time spent on manual tasks and improving cash flow management.
- Negotiated favorable repayment plans with delinquent customers, mitigating financial risk for the company.
- Consistently met or exceeded monthly targets for outstanding receivables reduction while maintaining positive client relations.
- Contributed to overall departmental goals by collaborating with cross-functional teams on process improvements and new initiatives.
- Reduced delinquency rates by closely monitoring account statuses and initiating timely follow-ups with clients.
- Minimized bad debt exposure through diligent account monitoring and proactive intervention strategies.
- Collected on delinquent accounts to reduce overdue balances.
- Maintained high volume of calls and met demands of busy and productive group.
- Resolved customer disputes and disagreements through professional, calm communication to find mutually beneficial solutions.
- Achieved performance goals on consistent basis.
- Developed strong relationships with customers to foster timely payments and account resolution.
Education
Law Enforcement And General Studies
South Plains College
Levelland, TXHigh School Diploma -
Cotton Center High School
Cotton Center, TX05.1987
Skills
- Case Evaluation
- Verbal Communication
- Policy Interpretation
- Claims Investigation
- Critical Thinking
- Computer Skills
- Customer service and support
- Team Collaboration
- Active Listening
- Claims
- Decision-Making
- Claims Processing
- Relationship Building
- Insurance policy coverage knowledge
- Claims Evaluation
- Claims adjustment
- Report and Records Review
- Coverage Determination
- MS Office
- Payment Processing
- Settlement Negotiations
- Settlement Negotiation
- Denied claims identification
- Microsoft Office Suite
- Policy analysis
- Records Review
- Coverage Assessment
- Report Writing
- Database Management
- Claim Form Analysis
- Regulatory Compliance
- Microsoft Publisher
Languages
Spanish
Native or Bilingual
Timeline
Appeals Analyst
Experian Health
11.2016 - 02.2024
Office Credit Collections Clerk II
Medtronic
08.2013 - 11.2016
Law Enforcement And General Studies
South Plains College
High School Diploma -
Cotton Center High School
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