Sylvia Rosado
Riverview,FL
Summary
Efficient Claims Coordinator known for high productivity and completing tasks swiftly. Possess specialized skills in claim processing, dispute resolution, and policy interpretation. Excel in communication, problem-solving, and organization, ensuring smooth operations and customer satisfaction.
Overview
14
14
years of professional experience
Work History
Claims Coordinator
Southeast Independent Deliveries
Lakeland, FL
11.2021 - Current
- Provided training and guidance to new staff members on filing procedures and regulations.
- Researched and resolved discrepancies between customer accounts and billing statements.
- Reviewed and processed insurance claims for accuracy and completeness.
- Analyzed trends in claim processing to identify areas for improvement.
- Performed regular reviews of existing policies to ensure accuracy and compliance with current standards.
- Processed requests for additional information from third parties as needed.
- Communicated regularly with clients regarding the progress of their claim.
- Provided leadership, insight and mentoring to newly hired employees to supply knowledge of various company programs.
- Implemented departmental policies and standards in conjunction with management to streamline internal processes.
Administrative Assistant
Southern Winding
Tampa, FL
02.2021 - Current
- Maintained office supplies inventory by checking stock to determine inventory level; anticipating needed supplies; placing and expediting orders for supplies.
- Handled confidential documents in an organized fashion according to established protocol.
- Organized and maintained filing systems for physical and electronic documents, ensuring accuracy and confidentiality of records.
- Greeted visitors in a professional manner, responding to inquiries and directing them to appropriate personnel.
- Developed and maintained filing systems for confidential documents and records.
- Processed invoices for payment using accounting software applications.
- Managed incoming calls while providing information or transferring callers to appropriate personnel.
- Assisted in the development of departmental policies and procedures related to Accounts Receivable collections.
- Accepted and processed customer payments and applied toward account balances.
Insurance Claims Specialist
Optum
Tampa, Florida
11.2010 - 11.2020
- Negotiated settlements between claimants and insurers when necessary to resolve disputes quickly.
- Calculated benefit payments based on policy terms, coverage limits, and applicable regulations.
- Provided guidance to customers regarding their rights and obligations under the insurance policies.
- Resolved customer complaints related to insurance claim processing.
- Processed requests for additional documentation from customers in a timely manner.
- Reviewed denied claims for errors or omissions before finalizing decision notices.
- Ensured compliance with state laws governing insurance practices as well as company policies and procedures.
- Collaborated with team members to identify trends in customer issues and develop solutions accordingly.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Precisely calculated refunds, premiums, and adjustments.
- Organized information by using spreadsheets, databases or word processing applications.
- Collaborated with fellow team members to manage large volume of claims.
- Transcribed data to worksheets and entered data into computer to prepare documents and adjust accounts.
Education
High School Diploma -
Tampa Bay Technical High School
TampaSkills
- Policy Interpretation
- Claims Management
- Insurance knowledge
- Financial Acumen
- Microsoft Office
- Office Management
Languages
Spanish
Professional
English
Professional
Accomplishments
Employee of the month for February. Selected out of a company of 350 employees.
References
References available upon request.
Timeline
Claims Coordinator
Southeast Independent Deliveries
11.2021 - Current
Administrative Assistant
Southern Winding
02.2021 - Current
Insurance Claims Specialist
Optum
11.2010 - 11.2020
High School Diploma -
Tampa Bay Technical High School
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