Teresa Barela
West Valley City
Summary
Professional appeals specialist prepared for roles that demand high standards and results-driven approach. Proven track record in managing complex appeals, leading to successful outcomes and enhanced procedural efficiency. Collaborative team player with focus on adaptability and achieving organizational goals. Strong skills in dispute resolution and regulatory compliance.
Overview
16
16
years of professional experience
Work History
Appeals Coordinator
P.E.H.P. Public Employee Health Program
01.2010 - Current
- Acted as a departmental resource on appeals matters.
- Created, composed and maintained appeal response templates.
- Coordinated with senior specialist to compose appeal responses.
- Responded to attorney inquiries and litigation notices.
- Developed appeals functions, policies and procedures and documentation.
- Contributed to a positive work environment by sharing best practices among colleagues; improving overall team performance.
- Developed strong working relationships with internal and external stakeholders, fostering a collaborative environment for efficient resolution of appeals.
- Organized and managed appeals caseloads, prioritizing high-priority cases for timely resolution.
- Collaborated with cross-functional teams, resulting in improved communication and quicker resolutions.
- Streamlined appeals process for increased efficiency through consistent tracking and monitoring of cases.
- Implemented process improvements based on audit findings, enhancing overall quality and efficiency within the department.
- Maintained comprehensive knowledge of regulatory guidelines to ensure compliance within the appeals department.
- Managed timelines effectively by scheduling hearings or mediations as required, meeting all deadlines consistently.
- Conducted detailed audits on case files, ensuring accuracy and completeness of information for better decisionmaking.
- Enhanced appeal resolution rates by thoroughly reviewing and analyzing case documentation.
- Participated in regular meetings with management to provide updates on case status and discuss potential improvements in processes.
- Ensured confidentiality of sensitive information by following strict security protocols throughout the appeals process.
- Coordinated with medical professionals and subject matter experts for case reviews, obtaining necessary clarification for accurate decisionmaking.
- Assisted in the development of training materials, contributing to the improvement of team performance and expertise.
- Provided exceptional customer service by promptly responding to inquiries from appellants and other stakeholders.
Customer Service Representative
P.E.H.P. Public Employee Health Benefits
11.2008 - 01.2010
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Contributed to sales growth by upselling products and services based on individual customer requirements.
- Participated in training programs to enhance product knowledge and customer service skills.
- Maintained detailed records of customer interactions, contributing to comprehensive database for future reference.
- Maintained detailed records of customer interactions and transactions, ensuring accurate documentation and follow-up.
- Updated company's FAQ section to include answers to common customer questions, reducing inquiry volume.
- Negotiated solutions with dissatisfied customers, turning potential negative reviews into positive testimonials.
- Improved resolution time with effective problem-solving for customer complaints.
Education
High School Diploma -
Taylorsville Highschool
Utah01-2002
Skills
- Data entry proficiency
- Policy interpretation
- Confidentiality
- Insurance regulations
- HIPAA compliance
- Effective communication
- Medical terminology
- Documentation expertise
- Teamwork and collaboration
- Problem-solving
- Time management
- Multitasking skills
- Attention to detail
- Listening skills
- Problem-solving abilities
- Reliability
- Critical thinking
- Organizational skills
- Self motivation
- Complaint handling
- Professionalism
- Goal setting
Timeline
Appeals Coordinator
P.E.H.P. Public Employee Health Program
01.2010 - Current
Customer Service Representative
P.E.H.P. Public Employee Health Benefits
11.2008 - 01.2010
High School Diploma -
Taylorsville Highschool
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