Summary
Overview
Work History
Education
Skills
Certifications Training
Accomplishments
Timeline
Generic

Natica Almodovar

Dothan,AL

Summary

Adept at data analysis and fostering strong customer relationships, I excelled at CareMetx by streamlining insurance processes, enhancing patient satisfaction, and surpassing sales goals. My expertise in Microsoft Excel and conflict resolution propelled operational efficiencies and quality control, achieving a notable increase in customer retention rates. Committed Reimbursement Specialist with a recognized proficiency in client service and administrative support. Skilled in policy evaluation and negotiating claims. Offering a specialty in insurance in addition to a general industry knowledgeability.

Overview

5
5
years of professional experience

Work History

Reimbursement Analyst

CareMetx
01.2023 - 02.2025
  • Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program
  • Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications
  • Completes and submits all necessary insurance forms in a timely manner as required by all third party payors for prior authorizations
  • Tracks and follow up on prior authorization request
  • Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
  • Maintains frequent phone contact with provider representatives, third party customer service representatives, and pharmacy staff
  • Reports any reimbursement trends/delays to supervisor
  • Processes any necessary insurance/patient correspondence
  • Provides all necessary documentation required to expedite prior authorization request
  • This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians
  • Coordinates with inter-departmental associates as necessary
  • Communicates effectively to payors to ensure accurate and timely benefit investigations
  • Works on problems of moderate scope where analysis of data requires a review of a variety of factors
  • Exercises judgment within defined standard operating procedures to determine appropriate action
  • Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedure

Retention Specialist

Spectrum
01.2022 - 01.2023
  • Maintained a high level of customer satisfaction, professionalism, and courtesy in all retention transactions
  • Consistently exceeded weekly sales goals by utilizing effective telephone-based customer saving techniques
  • Consistently exceeded monthly sales goals by utilizing effective telephone-based customer saving techniques
  • Consistently exceeded retention activity goals by utilizing effective telephone-based customer saving techniques
  • Promptly and efficiently responded to inbound retention calls
  • Adhered to required call handling metrics including productive time, schedule adherence, handle time, and after-call work
  • Addressed inquiries regarding billing, pricing, packaging, and service complaints
  • Learned and excelled in order processing within the billing system, managing all aspects of retained accounts
  • Performed new sales order entry
  • Managed accounts payable
  • Utilized various tools and functions related to retention strategies
  • Demonstrated proficiency in effectively explaining products and services to existing customers for re-selling and retention purposes
  • Communicated extensive knowledge of competitors' pricing, packaging, and products
  • Conducted detailed analysis of business and competitors' products and services

Customer Service Representative

IQORR
04.2021 - 01.2022
  • Answered inbound calls, greeted customers, and placed outbound calls to ensure smooth communication with customers
  • Developed and maintained strong relationships with clients, customers, and call center team members
  • Consistently achieved or surpassed call center metrics while delivering exceptional customer service
  • Successfully completed department productivity and quality standards to meet company goals
  • Effectively facilitated resolution for customer needs and issues by providing prompt and satisfactory solutions
  • Effectively resolved customer issues in a single call by following instructions and guidelines
  • Provided timely and efficient resolution to a variety of customer inquiries and concerns
  • Educated customers about our client's products and services to enhance their understanding and promote sales

Supervisor

Amazon
CLT2 Fulfillment Center
08.2020 - 04.2021
  • Overseeing the general operations and its staff
  • Recording and maintaining of inventory, advising the imports received and items exported
  • Transports materials and items from receiving or production areas to storage or to other designated areas
  • Fills requisitions, work orders, or requests for materials, or other stock items and distribute them
  • Train new workers and ensure their performance is adequate
  • Forklift operator/ Cherry picker/ high lift/ sit down forklift
  • Picking packing Quality Control operations
  • Read blueprints and specifications
  • Monitor operations to ensure that staff met production standards
  • Recommended adjustments to the assembly or production process
  • Inspect, test, or measure materials
  • Measured products with calipers, gauges, or micrometers
  • Operated electronic inspection equipment and software
  • Problem solving skills in high stress situations

Lead Package Handler

FedEx
01.2020 - 08.2020
  • Provided customer service in warehouse distribution
  • Exhibited leadership in Preloading Package Sales
  • Manually moved materials in packages from one truck to another
  • Picking packing
  • Shipping
  • Tagging
  • Inventory
  • QA /Quality control - inspected freight & damaged goods, processed returns through the company
  • Performed audits
  • Weigh, move, or check products
  • Examine products or materials, parts, subassemblies, and packaging for damage, defects, or shortages, using specification sheets, gauges, and standards charts

Education

Bachelor's - Psychology

Winthrop University
Rockhill, SC
12.2024

High school - Academic

Douglas County High School
Douglasville, GA
05.2018

Skills

  • Data analysis
  • Customer service
  • Microsoft Excel
  • Research methods
  • Communication skills
  • Conflict resolution
  • Picking, packing
  • Shipping
  • Inventory
  • QA /Quality control

Certifications Training

  • Bachelor's in Psychology, Winthrop University, Rockhill, SC, 08/01/18, 12/01/24
  • High school in Academic, Douglas County High School, Douglasville, GA, 08/01/14, 05/01/18

Accomplishments

  • ALPHA KAPPA ALPHA SORRORITY INC

Timeline

Reimbursement Analyst

CareMetx
01.2023 - 02.2025

Retention Specialist

Spectrum
01.2022 - 01.2023

Customer Service Representative

IQORR
04.2021 - 01.2022

Supervisor

Amazon
08.2020 - 04.2021

Lead Package Handler

FedEx
01.2020 - 08.2020

Bachelor's - Psychology

Winthrop University

High school - Academic

Douglas County High School
Natica Almodovar