Summary
Overview
Work History
Education
Skills
Timeline
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Teresa Hernandez

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

30
30
years of professional experience

Work History

Claims Analyst

Optum
05.2011 - Current
  • Streamlined arbitration processes by implementing efficient case management systems and procedures.
  • Enhanced client satisfaction rates by effectively resolving disputes through negotiation techniques.
  • Managed caseloads of multiple complex arbitration cases, ensuring timely resolution and adherence to deadlines.
  • Developed strong relationships with clients, facility's, and arbitrators for improved communication and successful outcomes.
  • Maintained detailed records of each case''s progress, ensuring transparency throughout the arbitration process.
  • Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all negotiations.
  • Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
  • Provided exceptional customer service by promptly addressing inquiries from policyholders, agents, and other stakeholders regarding the status of their claims.
  • Self-motivated, with a strong sense of personal responsibility.
  • Skilled at working independently and collaboratively in a team environment.
  • Proven ability to learn quickly and adapt to new situations.
  • Worked well in a team setting, providing support and guidance.
  • Worked effectively in fast-paced environments.
  • Managed time efficiently in order to complete all tasks within deadlines.
  • Excellent communication skills, both verbal and written.
  • Passionate about learning and committed to continual improvement.

Customer Service Supervisor

ComPsych Corporation
12.2002 - 05.2025
  • Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.
  • Enhanced team productivity through regular coaching, feedback, and performance evaluations.
  • Streamlined workflow processes for increased efficiency in handling customer inquiries and complaints.
  • Collaborated with other departments to address recurring customer concerns, improving overall service quality.
  • Developed comprehensive training materials for new hires, ensuring consistent knowledge and skill development across the team.
  • Implemented effective scheduling strategies to optimize staff coverage during peak hours and minimize wait times for customers.
  • Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
  • Evaluated individual performance metrics to identify areas of improvement, providing targeted coaching to boost results.
  • Monitored call center data to assess trends, proactively implementing solutions for identified issues.
  • Conducted regular quality assurance checks on team interactions with customers, ensuring adherence to company standards.

Customer Service/Claims Liaison

Magellan Behavioral Health
12.1997 - 12.2022
  • Enhanced claim resolution times by streamlining communication between clients and insurance carriers.
  • Reduced overall claim processing time by implementing efficient tracking and documentation practices.
  • Ensured timely submission of claims by closely monitoring deadlines, resulting in improved client satisfaction.
  • Improved the accuracy of processed claims through meticulous review and verification of all supporting documents.
  • Collaborated with adjusters to negotiate fair settlements for clients, prioritizing their best interests.
  • Provided exceptional customer service to policyholders during the claims process, maintaining a professional and empathetic approach.

Front End Manager

Fairplay Finer Foods
01.1995 - 04.2006
  • Enhanced customer satisfaction by streamlining front-end operations and implementing efficient check-out procedures.
  • Reduced wait times for customers by optimizing staff scheduling and improving employee productivity.
  • Boosted employee morale and reduced turnover by cultivating a positive work environment and providing regular feedback and recognition.
  • Maintained excellent store appearance by enforcing cleanliness standards and delegating tasks to team members effectively.
  • Collaborated with other department managers to develop cross-functional initiatives, fostering a cohesive store environment.
  • Resolved customer complaints promptly, reinforcing the company''s commitment to exceptional service standards.
  • Oversaw cash handling procedures, minimizing discrepancies in end-of-day reports through diligent monitoring of transactions.
  • Promoted from cashier to front end manager within two years, demonstrating rapid growth in leadership abilities and operational knowledge.

Education

No Degree - Early Childhood Education

Richard J. Dailey College
Burbank, IL

No Degree - General Office Services

Spanish Collation Vocational College
Chicago
06.1989

High School Diploma -

William J. Bogan High School
Chicago
06.1988

Skills

  • Claims
  • Document workflow
  • Dispute tracking
  • Interpersonal and written communication
  • Claims review
  • Claims analysis
  • Claim investigation
  • Critical Thinking
  • Client Interviewing
  • Settlement Negotiations
  • Team Collaboration
  • Relationship Building
  • Decision-Making

Timeline

Claims Analyst

Optum
05.2011 - Current

Customer Service Supervisor

ComPsych Corporation
12.2002 - 05.2025

Customer Service/Claims Liaison

Magellan Behavioral Health
12.1997 - 12.2022

Front End Manager

Fairplay Finer Foods
01.1995 - 04.2006

No Degree - Early Childhood Education

Richard J. Dailey College

No Degree - General Office Services

Spanish Collation Vocational College

High School Diploma -

William J. Bogan High School

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Teresa Hernandez