Nancy Palafox
San Bernardino,CA
Summary
Educational professional with solid experience in school administration and office management. Known for ensuring smooth daily operations, handling confidential information, and optimizing administrative processes. Highly collaborative team player with focus on achieving results and adapting to dynamic environments.
Overview
7
7
years of professional experience
Work History
Claim Benefit Specialist
Aetna, a CVS Health
Work At Home - California
03.2022 - Current
- Reviewed and processed medical claims for accuracy, completeness, and adherence to insurance policies and guidelines
- Investigated and resolved complex claim issues by analyzing medical records, policy documents, and billing information
- Identified potentially fraudulent activities or billing errors through careful analysis of claims data
- Maintained a high level of productivity while meeting quality standards in processing a large volume of claims daily
- Utilized coding systems such as CPT, ICD-10, HCPCS to accurately assign appropriate reimbursement codes for services rendered
- Verified patient eligibility and coverage benefits prior to claim submission
- Assisted in the development and implementation of new processes to improve efficiency in claims processing workflow
- Provided training and guidance to new team members on medical coding guidelines and best practices for claims processing
- Identified opportunities for cost savings by identifying overpaid or duplicate payments
- Participated in regular meetings with management to discuss process improvements, challenges, and opportunities for streamlining operations
- Implemented quality control measures to ensure compliance with regulatory requirements and industry standards
- Demonstrated expertise in interpreting insurance policies, contracts, and fee schedules to accurately determine claim eligibility and reimbursement amounts
- Served as a subject-matter expert on medical coding guidelines including CPT, ICD-10, HCPCS codes
School Assistant
Stone Ridge Academy
Upland, CA 91786
10.2019 - 03.2022
- Handled incoming calls, took messages, and directed inquiries to appropriate staff members
- Managed email correspondence by responding to inquiries promptly and forwarding important messages to relevant parties
- Performed general administrative tasks including photocopying, scanning documents, mailing letters/packages, etc
- Collaborated with other departments to facilitate smooth communication flow within the organization
- Assisted in onboarding new employees by preparing necessary paperwork and coordinating orientation schedules
- Maintained confidentiality of sensitive information while handling employee records or company-related documents
- Created spreadsheets or databases to track various office metrics such as expenses or inventory levels for reporting purposes
- Supported HR department in recruitment efforts by reviewing resumes and scheduling interviews
- Coordinated office equipment maintenance and repairs to ensure smooth operations
- Maintained electronic and physical filing systems to ensure easy retrieval of documents
- Assisted in the preparation of reports, presentations, and correspondence by gathering data and formatting information
- Coordinated office events such as team-building activities or celebrations to foster a positive work environment
- Provided support in organizing company-wide training sessions or workshops for employees' professional development
- Maintained accurate records of library materials, including cataloging new acquisitions and updating existing entries
- Organized and shelved books according to the Dewey Decimal System, ensuring easy access for library users
- Performed routine maintenance tasks such as cleaning shelves, repairing damaged books, and restocking supplies
- Assisted in planning and executing library programs and events for all age groups
- Assisted patrons with locating and checking out books, ensuring a positive customer experience
- Provided one-on-one support to students with special needs, helping them achieve academic goals
- Managed classroom behavior by implementing positive reinforcement strategies and maintaining a safe learning environment
- Facilitated small group discussions and activities to enhance student comprehension of lesson content
- Assisted in the supervision of students during recess, lunchtime, and field trips
- Implemented individualized education plans (IEPs) for students with disabilities, ensuring their specific needs were met
- Created a positive learning environment by fostering strong relationships with students based on trust and respect
- Collaborated with school counselors to address behavioral or emotional issues affecting student performance
- Assisted in the preparation of instructional materials such as worksheets, handouts, and visual aids
- Maintained accurate records of student attendance, grades, and behavior incidents
- Demonstrated patience when working with challenging behaviors or difficult situations
- Collaborated with lead teacher to create a positive classroom environment that encouraged student participation and engagement
- Maintained accurate and up-to-date employee records, including personal information, attendance, and performance evaluations
- Managed new hire onboarding process, ensuring completion of paperwork and orientation sessions
- Administered benefits enrollment process by providing employees with necessary forms and explaining coverage options
- Maintained confidentiality of sensitive HR information while handling employee data with utmost professionalism
- Provided guidance to employees regarding company policies, procedures, and code of conduct
- Maintained confidentiality when handling sensitive information such as medical records or disciplinary actions taken against employees
Cafe Associate
Sam's Club
San Bernardino, CA 92408
07.2018 - 10.2019
- Maintained clean and presentable cafe by wiping, sanitizing, and replenishing supplies frequently to support workflow efficiency and employee job tasks.
- Exceeded customer expectations by providing welcoming environment and prompt and friendly service to people of diverse backgrounds.
- Wiped, sanitized and maintained floors, facility, and equipment to adhere with company standards and procedures.
- Checked proper temperature of food to maintain food safety standards and reduce illness.
- Provided exceptional customer service, addressing concerns promptly and professionally.
- Produced food and drink products adhering to company quality and quantity standards.
- Displayed calm and friendly demeanor when addressing and resolving customer issues and complaints.
- Notified management of product and supply shortages to reduce disruption in availability.
- Operated point-of-sales system and securely handled cash and credit card payments to drive business profitability.
- Determined customer needs, assisted with selection, and promptly served items to foster positive guest experience.
- Increased repeat business by fostering positive relationships with regular customers.
- Replenished products daily for optimal freshness and visibility.
- Supported training of new staff members, sharing best practices for success in their roles.
- Resolved any conflicts that arose among co-workers or between staff and customers, leading to a more harmonious work environment.
- Enhanced customer satisfaction by providing efficient and friendly service in a fast-paced cafe environment.
- Ensured seamless shift transitions by effectively communicating pertinent information between team members during handovers.
- Implemented cost-saving measures by reducing waste through proper portion control and storage techniques.
- Trained and supervised new staff to enhance customer service skills and comply with food safety standards.
Education
High School Diploma -
John Glenn High School
Norwalk, CA 9065006-2012
Skills
- Data entry proficiency
- Benefits administration
- Policy interpretation
- Strong organization
- Maintaining confidentiality
- Classroom support
- Student supervision
- Administrative tasks
- Parent-teacher liaison
- Proficient in Computer Applications
- Fast Adaptation Skills
- Fluent in English and Spanish
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Claim Benefit Specialist
Aetna, a CVS Health
03.2022 - Current
School Assistant
Stone Ridge Academy
10.2019 - 03.2022
Cafe Associate
Sam's Club
07.2018 - 10.2019
High School Diploma -
John Glenn High School