Nacya Acosta
Phoenix,AZ
Summary
Customer Service Specialist who is detail-oriented and well organized exercising an excellent customer service aptitude, my ability to serve a diverse clientele will make significant contributions to your company.
Overview
8
8
years of professional experience
Work History
Fraud and claims operation specialist 2
Wells Fargo Inc., Chandler
Chandler
01.2020 - 02.2024
- Daily working non-fraud billing disputes efficiently and making outbound calls to account holders unique to their dispute reasoning with concern and understanding
- Communicate between other Wells Fargo analysis teams together and or provide information regarding disputed claims and or transactions
- Use great analytical skills to determine the correct resolution for each claim
- Navigate between dual monitors using multiple data applications efficiently while using telephone
- Mail out appropriate letters to account holder’s residence with information that vary from the final decision of each claim to document request forms.
- Apply additional disputed transactions if related to the claim based on dispute reasoning
- Submit request forms for replacement debit cards to existing account holders when a fraud claim has been reported
- Abide by internal procedures and requirements as well as accurately adhering to Regulation E.
- Analyzed operational processes to identify inefficiencies and recommend improvements.
- Coordinated cross-functional communication to streamline project workflows and enhance collaboration.
- Managed data entry tasks using internal systems to maintain accurate records and support team objectives.
- Conducted regular audits of operational procedures to uphold performance metrics and drive continuous improvement initiatives.
- Delivered actionable insights through data analysis, enabling informed decision-making across various operational functions.
- Oversaw day-to-day operations, delegating tasks appropriately to ensure smooth workflow and timely completion of projects.
- Boosted customer satisfaction, addressing client concerns in a timely and professional manner.
Customer Service Representative
Avesis Insurance Company, Peoria
Peoria
05.2016 - 10.2020
- Handle up to 60 calls dailyAssist consumers, policy holders, physicians, and physicians' assistants with inquiries
- Abide by HIPAA Laws
- Explain plan benefits regarding dental, vision, and hearing
- Generate authorization codes for physicians to administer services on consumers
- Explain reasoning of denial for prior authorization
- Properly gave information on covered/non covered services to Consumers, physicians, and physicians' assistants
- Inform consumers on which physicians office available in their network
- Mail Explanation of benefits and/or insurance cards when requested
- Processed insurance claims accurately, maintaining compliance with company policies and regulatory standards.
- Collaborated with cross-functional teams to streamline customer service workflows and enhance communication strategies.
- Trained new representatives on product knowledge, systems usage, and effective customer interaction techniques.
- Analyzed customer feedback to identify trends, driving improvements in service delivery and client engagement.
- Led team meetings focused on performance metrics, fostering a culture of accountability and continuous improvement.
- Developed training materials that improved onboarding processes for new hires within the department.
- Implemented best practices for handling complex cases, improving resolution times and reducing escalations.
Education
Diploma -
South Pointe High School
PhoenixSkills
- Hogan software
- Claims Processing
- Word
- SAP
- Medical Terminology
- HIPAA
- Microsoft Publisher
- Analysis Skills
- Insurance Verification
- Medical Office Experience
- Medical Coding
- Cross-functional communication
- Planning and coordination
- Operational efficiency
Languages
Spanish
Full Professional
Timeline
Fraud and claims operation specialist 2
Wells Fargo Inc., Chandler
01.2020 - 02.2024
Customer Service Representative
Avesis Insurance Company, Peoria
05.2016 - 10.2020
Diploma -
South Pointe High School