Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Sandy Sanjurjo

Pembroke Pines,FL

Summary

To obtain a challenging position in which I can fully utilize my skills and gain experience to benefit the organization. Seeking a position as Claim examiner where extensive experience will be further developed and utilized.

Overview

16
16
years of professional experience

Work History

Medical Claims Processor – Team Lead

GMMI
12.2018 - Current
  • Translated and processed international claims
  • Coached, motivated and developed team to ensure quality goal is met
  • Created batches and monitored daily inventory to ensure TAT goals
  • Met and exceeded quality goal of 99% in accurately processing claims
  • Served as subject matter expert for the translation team
  • Provided training and mentoring to new hires
  • Demonstrated problem-solving skills to identify pivoted issued and strategies to move claim to resolution.
  • Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
  • Researched and resolved complex medical claims issues to support timely processing.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Managed large volume of medical claims on daily basis.
  • Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.

Claims Examiner

AXA ASSISTANCE USA
01.2013 - 02.2018
  • Processes international claims for BlueCross BlueShield and Federal Employee programs
  • Reviews all necessary claim documentation for accuracy and completeness
  • Negotiates payment scales with international health providers
  • Effectively communicates with providers from over 40 countries
  • Key player in securing a successful extension of the Federal Employee Program for 5 more years.

Operation Assistant Manager

AMERICA SUNSHINE
01.2009 - 01.2012
  • Assists managing eight warehouse employees in the accomplishment of their daily duties
  • Supervises the effectiveness of the warehouse conveyor system, assuring balance and timing
  • Trains all new hires in the shipping, packing and ERP system procedures
  • Ensures minimum error occurrence while keeping a safe environment
  • Ensures efficient collaboration with FEDEX shipping services
  • Received, unpacked, and checked arriving shipments, attending to the company operating guidelines
  • Assisted in the accurate implantation of FIFO inventory controls
  • Forklifts certified (Crown SP 3000).

Loss Prevention Supervisor

KING CITY THEME PARK
01.2008 - 01.2009
  • Communicated effectively with inside security personnel to ensure overall safety
  • Ensure that minors were accompanied by their parents at every time
  • Supervised overall Cleanliness of multiple playing rooms accuracy.

Education

Bachelor of Business Administration -

University of Turabo

Business Administration -

Universidad De Oriente

Skills

  • Proficient in Microsoft Office (Word, Excel, PowerPoint)
  • Systems: QuickBooks, Citrix, Submission Prod, Mag
  • Effective communicator and team player
  • Very detailed-oriented and fast learner
  • Able to meet deadlines accurately

References

  • Kelly Fulton, BlueCross BlueShield Claims Manager, (786) 210-0597
  • Rey Mercado, Accounting Professor, (954) 559-8435
  • Mark Barilla, AXA Assistance Human Resources Manager, (305) 893-5151
  • Tania Reyes, GMMI Claims Manager, (305) 788-7473

Timeline

Medical Claims Processor – Team Lead

GMMI
12.2018 - Current

Claims Examiner

AXA ASSISTANCE USA
01.2013 - 02.2018

Operation Assistant Manager

AMERICA SUNSHINE
01.2009 - 01.2012

Loss Prevention Supervisor

KING CITY THEME PARK
01.2008 - 01.2009

Bachelor of Business Administration -

University of Turabo

Business Administration -

Universidad De Oriente

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Sandy Sanjurjo