Mesmer Aurelus
Queens Village,NY
Summary
Efficient professional in insurance claims and policy processing, known for high productivity and the ability to complete tasks with precision. Specialized in analyzing claim details, navigating policy databases, and managing customer communications. Excel in problem-solving, adaptability, and teamwork, leveraging these soft skills to navigate complex situations and achieve positive outcomes. Capable claims representative adept at claims investigations, information review and settlement management. Positive and reliable professional with a detail-oriented and systematic approach. Bringing several years of related experience.
Overview
21
21
years of professional experience
Work History
Claims Representative
Metroplus Health
New York, NY
05.2022 - Current
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Examined claims, records and procedures to grant approval of coverage.
- Coordinated and planned investigations of claims to confirm compensability and coverage.
Project Coordinator
FIDELIS CARE ORGANIZATION
01.2013 - 05.2022
- Liaison between Customers (Members/Providers)
- Works with customers to assist in solving problems
- Enabling use of products, services and providing information, and fulfilling other needs as appropriate
- Maintaining high customer service standards as designated by organizational policies and procedures
- Prioritized needs and delegated assignments to simultaneously handle multiple projects.
- Created project status presentations for delivery to customers or project personnel.
- Drafted presentations outlining the current state of specific projects for review by senior managers.
Scheduling Coordinator
MOUNT SINAI HOSPITAL
01.2011 - 01.2013
- Schedules patient FPA appointments and updates practice management system
- Collects patient demographics and insurance information
- May schedule patients' appointments for tests or consults
- May initiate reminder calls for next day's appointments
Client Service Representative
NEW YORK LIFE INSURANCE
01.2007 - 01.2010
- Provide financial services to policy owner and agent via a High Volume Call Center by answering Products inquiries, quoting fund values & exploring policy provision
- Process full & partial surrender/withdrawal including IRS section 1035 exchange
- Calculate required minimum distribution for IRA plan, TSA plan SEP plans in accordance with IRA regulation
Insurance Underwriter/Customer Service
AUTO ONE INSURANCE
01.2004 - 01.2007
- Evaluate information both for usefulness and profitability of the risk
- Identify potential hazard and propose technique to control them
- Select proper alternative underwriting actions in given situation based on relevant underwriting criteria, and implement decisions
- Apply technique for monitoring and correcting decisions
- Determine loss ratios, expenses ratios and combined ratios
Education
Some College (No Degree) -
New York Institute of Technology
Old Westbury, NYSkills
- Microsoft Word
- WordPerfect
- Xerox Copiers
- Epaces
- Organizational skills
- Detail-oriented
- Insurance claims review
- Interpersonal communication
References
Available upon request.
Timeline
Claims Representative
Metroplus Health
05.2022 - Current
Project Coordinator
FIDELIS CARE ORGANIZATION
01.2013 - 05.2022
Scheduling Coordinator
MOUNT SINAI HOSPITAL
01.2011 - 01.2013
Client Service Representative
NEW YORK LIFE INSURANCE
01.2007 - 01.2010
Insurance Underwriter/Customer Service
AUTO ONE INSURANCE
01.2004 - 01.2007
Some College (No Degree) -
New York Institute of Technology
Similar Profiles
Endy Rodriguez ArveloEndy Rodriguez Arvelo
Marketing Facilitated Enroller at Metroplus HealthMarketing Facilitated Enroller at Metroplus Health
Samantha PaulinoSamantha Paulino
Health Communications Intern at MetroPlus HealthHealth Communications Intern at MetroPlus Health
DORYS GABRIELA MAYORGADORYS GABRIELA MAYORGA
Senior Manager of Brand Partnerships and Experiential at MetroPlus HealthSenior Manager of Brand Partnerships and Experiential at MetroPlus Health