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, SC12.2024
High school - Academic
Douglas County High School
Douglasville, GA05.2018
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
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