Neisha Victoria Paulino Rivera
Worcester,MA
Summary
Adept at driving financial and insurance solutions, I leveraged Microsoft Office and negotiation skills at Sonia's Auto Sales and Triple SSS Management to enhance customer satisfaction and streamline claims processing. My proactive approach and ability to work under pressure led to significant business growth, showcasing my commitment to excellence and continuous learning.
Overview
12
12
years of professional experience
Work History
Finance Manager
Sonia's Auto Sales
11.2017 - 03.2024
- Developed strong relationships with banks, credit unions, and other lending institutions to secure the best financing options for customers.
- Ensured compliance with federal regulations and company policies regarding automotive financing transactions.
- Collaborated with sales managers to develop effective strategies for overcoming financial obstacles during vehicle negotiations.
- Assisted customers with challenging credit histories in securing suitable loan options to facilitate vehicle purchases.
- Maximized profitability by negotiating and structuring optimal automotive financing deals.
- Optimized dealership revenue by identifying opportunities for additional product offerings such as extended warranties and insurance packages.
- Demonstrated expertise in various financial products, creating tailored presentations for customers, showcasing the benefits of specific financing plans based on their unique needs.
- Maintained an organized workflow by prioritizing tasks effectively managing multiple client files simultaneously ensuring timely processing of all transactions.
- Enhanced dealership sales by providing comprehensive financial solutions to clients seeking vehicle purchase or lease agreements.
- Processed loan applications and monitored progress from start to finish.
- Developed and maintained relationships with customers, lenders and other third parties.
- Negotiated loan terms and conditions with customers to secure best deal.
- Established plans and payoffs for customers' loans, prioritizing control of overall costs.
- Explained very technical financial information to applicants in easy to understand language.
- Assisted customers with completing loan applications and other paperwork.
- Assist clients with insurance companies, facilitating the process of acquiring the documents required for vehicle registration.
- Knowledge of organizing and filling out the documents required by the motor vehicle department.
Health Insurance Claims Analyst
Triple SSS Management A Member Of Blue Cross Blue Shield
05.2012 - 11.2017
- Resolved complex, severe exposure claims, using high service oriented file handling.
- Maintained claim files, such as records of settled claims, inventory of claims requiring detailed analysis.
- Verified and analyzed data used in settling claims to ensure that claims were valid and that settlements were made according to company practices and procedures.
- Examined claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Presented cases and participated in their discussion at claim committee meetings.
- Contacted by mail claimants, doctors, medical, specialist, or employers to get additional information.
- Conferred with legal counsel on claims requiring litigation.
- Reported overpayments, underpayments, and other irregularities.
- Communicated with reinsurance brokers to obtain information necessary for processing claims.
- Conducted detailed bill reviews to implement sound litigation management and expense control.
- Prepared reports to be submitted to company's data processing department.
- Investigated, evaluated and settled claims, applied technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Maintained compliance with industry regulations and company policies while adjudicating health insurance claims.
- Managed a high volume of claims daily, consistently meeting deadlines and maintaining a low error rate.
- Prevented financial losses due to fraudulent activities through vigilant monitoring, investigation, and reporting of suspicious claim patterns.
- Reduced error rates in claims adjudication through meticulous attention to detail and thorough documentation review.
- Supported growth in business revenue by maintaining an exceptional standard of accuracy in the adjudication process.
- Developed comprehensive understanding of medical terminology, coding systems, and billing procedures for accurate claim processing.
- Safeguarded patient confidentiality during the adjudication process by adhering to HIPAA guidelines and ensuring secure storage of personal information.
- Provided training to new employees on company guidelines, system navigation, and effective strategies for successful claims adjudication.
- Enhanced claim processing efficiency by implementing new software and streamlining workflows.
- Streamlined processes for efficient handling of large volumes of daily claims submissions without compromising quality or accuracy standards.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Generated reports on medical claims processing activities and results.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Trained in programs such as: Qnxt, Mainframe, CES, Code Manager, Printnet, HCPCS, ICD-9, ICES.
Education
Bachelor of Arts - Social Science With Concentration in Psychology
University of Puerto Rico
San Juan, PR12.2011
No Degree - 672 Hours Intensive Program in ESL
Clark University
Worcester, MA01.2008
High School Diploma -
Escuela Libre De Musica, Ernesto Ramos Antonini
San Juan, PR05.2005
Skills
- Sales professional
- Customer Satisfaction
- Goal Setting
- Coaching and training
- Willing to Learn
- Ability to work under pressure
- Skilled in Microsoft Office
- Responsible, organized, punctual and great personality
Languages
Spanish
Native or Bilingual
Timeline
Finance Manager
Sonia's Auto Sales
11.2017 - 03.2024
Health Insurance Claims Analyst
Triple SSS Management A Member Of Blue Cross Blue Shield
05.2012 - 11.2017
Bachelor of Arts - Social Science With Concentration in Psychology
University of Puerto Rico
No Degree - 672 Hours Intensive Program in ESL
Clark University
High School Diploma -
Escuela Libre De Musica, Ernesto Ramos Antonini
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