Summary
Overview
Work History
Education
Skills
Languages
Accomplishments
References
Timeline
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Teresa Macias

Santa Ana,CA

Summary

Results-driven Claims Examiner II at Western Growers Insurance Trust with expertise in claims processing and regulatory compliance. Proven ability to resolve complex benefit issues while enhancing customer relationships. Skilled in claims adjustment and adept at navigating intricate guidelines to ensure accurate claim resolutions. Committed to delivering exceptional service and support.

Overview

13
13
years of professional experience

Work History

Claims Examiner II

Western Growers Insurance Trust
Irvine, CA
11.2014 - Current
  • Examine claims, including pricing and processing, within established specific guidelines.
  • Review and process professional dental, vision, and Medicaid claims.
  • Manual intervention document information is required to examine claims that are over $5,000.
  • Process claims adjustment, repricing, and corrections.
  • Resolve benefit and eligibility issues that require detailed knowledge, support for customers, and examination within the claims processing guidelines.

Dealer Direct Specialist

Hyundai Motor Finance
Irvine, CA
07.2012 - 10.2013
  • Inbound-related calls transferred from Customer Service.
  • Place outbound calls to Lease Customers in the last 90 days of their lease.
  • Provide lease extension or pull-ahead support.
  • Handle the grounding process through Dealer Direct.
  • Prepare the date sheet for Market-Based Price.
  • Price vehicles through the Black Book.
  • Research vehicle trims through the invoice.

Education

High School Diploma -

Valley High School
Santa Ana, CA
06-1994

Skills

  • Claims processing
  • Regulatory compliance
  • Claims adjustment
  • Customer relationship management

Languages

English
Full Professional
Spanish
Full Professional

Accomplishments

Employee of The Year at Long Beach Acceptance Corp. 2003

References

References available upon request.

Timeline

Claims Examiner II

Western Growers Insurance Trust
11.2014 - Current

Dealer Direct Specialist

Hyundai Motor Finance
07.2012 - 10.2013

High School Diploma -

Valley High School

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