Alfonso Berumen
Azusa,CA
Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 5 years of insurance experience.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Claims service Representative II
09.2018 - Current
- Responding to large volume of inbound/outbound calls daily, as well as replying to emails
- Educate members/providers about insurance plan benefits and protocols
- Identify and report adverse trends/patterns, such as claims completion, errors, and problems
- Research claim inquiries to resolve discrepancies, identify reasons for overpayment and inconsistent claims
- Kept current on insurance regulations, laws, policies, and procedures.
Loss Prevention Detective
05.2016 - 08.2018
- Carry out operational audits
- Monitored closed circuit television systems
- Detect and investigate fraudulent employees
- Detect and apprehend shoplifters.
Education
Bachelor Of Arts, Administration of Justice -
CAL STATE FULLERTON
Fullerton, CA05.2015
Skills
- Fluent in Spanish (Speak, Read, And Write)
- Problem Solving
- Computer and word processing skills such as Power Point, Excel, Microsoft Word
- Insurance Regulations Knowledge
- Strong negotiation
- Claim investigation
- Team Collaboration
- Documentation Review
- Stress Tolerance
Certification
- 2019 Claims Excellence Award recipient.
- Arbitration panelist.
Personal Information
Title: Claims Service Representative II
Timeline
Claims service Representative II
09.2018 - Current
Loss Prevention Detective
05.2016 - 08.2018
Bachelor Of Arts, Administration of Justice -
CAL STATE FULLERTON