THESSALONICA PINEDA
Reconciliation Auditor
Las Vegas,Nevada
Summary
Dedicated Reconciliation Auditor who provides exceptional service through thorough analyzation , understanding and comprehension .
Detailed and goal oriented individual with successful at troubleshooting and handling discrepancy issues in a timely manner. Energetic , perfectionist and with strong time management skills who thrives in a fast-paced, dynamic environment. Friendly and enthusiastic who consistently meets metrics and satisfaction goals.
Overview
21
21
years of professional experience
Work History
Reconciliation Auditor
Elevance Health
Las Vegas, NV
09.2021 - Current
- Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
- Utilized spreadsheets to track, manipulate, interpret and communicate data.
- Assessed internal control risks of network through information system audits.
- Followed established auditing processes to meet internal and regulatory requirements.
- Maintained strong, working knowledge of Standards for the Professional Practice of Internal Auditing.
- Developed audit policies, guiding administrative and technical functions.
- Administered auditing program to address risks and evaluate compliance with regulatory requirements.
- Analyzed data and findings to prepare reports detailing financial information.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Executed audit phases and entered data into accounting software for analysis.
- Communicated with auditees staff to obtain necessary information for audits.
- Planned and executed follow-up audits at appropriate intervals.
Membership Representative , Ind. E& B .
Anthem , Inc.
3634 S Maryland Parkway , , Nevada
08.2019 - 09.2021
- Responsible for enrollment, billing activities and/or maintaining assigned accounts.
- Processed 834 and ad advanced knowledge of 834 membership and 820 discrepancy and able to reconcile issues .
- Verifies enrollment status, makes changes to records, researches and resolves enrollment system rejections; addresses variety of enrollment questions and/or concerns received through report / mail.
- Working reports for RECON , 820 Discrepancies , Rejected Reworks , Multiple ID's , User Fee , Policy ID's , Cancel Job reports.
- Works special report being assigned by managers / OE for Tier 2.
- Responds to inquiries concerning enrollment processes.
- Notifies clients of premium discrepancies through payment adjustment notices and detailed audits.
- Performs error output resolution for electronic eligibility and processes error discrepancy list.
- Maintains and reconciles premium bill, self-bill and individual billed accounts.
- May be responsible for loading rates to new groups and renewal/re-class groups within appropriate system.
- Thoroughly documents inquiry outcomes for accurate tracking and analysis.
- Performs basic job functions with help from co-workers, specialists and managers on non-basic issues.
- Maintains and reconciles premium bill, self-bill and individual billed accounts.
Customer Service Representative
Anthem, Inc.
3634 S Maryland Pkwy, Las Vegas, NV
07.2018 - 08.2019
- Set up and explained new membership contracts.
- Proposed settlements for uncomplicated issues to resolve claims.
- Tracked the progress of all outstanding insurance claims.
- Interviewed policyholders to verify information and obtain additional details.
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Checked level and type of coverage and evaluated contracts.
- Reported policy changes and company conditions affecting customer satisfaction.
- Addressed and answers incoming call by members inquiries and complaints each day.
- Followed up with customers on unresolved issues.
- Collected all premiums on or before effective date of coverage.
Customer Service Representative
Teletech
3700 S Maryland Pkwy., Suite 200 , Las Vegas , NV 89169
09.2017 - 06.2018
- Handled all customer relations issues in a gracious manner and in accordance with company policies.
- Resolved service, pricing and technical problems for customers by asking clear and specific questions.
- Analyzed call volume and average call time to monitor Customer Service Representative performance and productivity.
- Effectively managed a high-volume of inbound and outbound customer calls.
- Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.
- Improved call center functionality and service capacity by resolving customer complaints efficiently and quickly.
- Acted professionally and patiently when addressing negative customer feedback.
- Accurately documented, researched and resolved customer service issues.
- Handled inbound customer chat conversations and emails from various websites.
- Ensured that issues were handled quickly and within the parameters of company-mandated policies and procedures.
- Documented all customer information accurately in the computer system, providing dated notes for future reference.
Customer Service Specialist
Sutherland Global Services
8725 W Sahara Ave, Las Vegas, . NV 89117
10.2016 - 08.2017
- Mastery of customer service management systems and databases.
- Accurately documented, researched and resolved customer service issues.
- Improved call center functionality and service capacity by resolving customer complaints efficiently and quickly.
- Defused volatile customer situations calmly and courteously.
- Addressed and resolved customer product complaints empathetically and professionally.
- Referred unresolved customer grievances to designated departments for further investigation.
- Resolved service, pricing and technical problems for customers by asking clear and specific questions.
- Effectively managed a high-volume of inbound and outbound customer calls.
- Managed high call volume with tact and professionalism.
Customer Service Assistant
Elite Lighting
Commerce, CA
01.2012 - 07.2012
- Greeted customers entering the store to ascertain what each customer wanted or needed.
- Politely assisted customers in person and via telephone.
- Provided an elevated customer experience to generate a loyal client
- Recommended, selected and helped locate and obtain out-of-stock product based on customer requests.
- Investigated and resolved customer inquiries and complaints in a timely and empathetic manner.
- Ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems on the spot.
- Built long-term customer relationships and advised customers on purchases and promotions.
- Routinely answered customer questions regarding merchandized and pricing.
Dietary Aide And Carer
Gentle Care Homes
London , United Kingdom
02.2010 - 03.2011
- Worked hand in hand with the Dietary Manager .
- Assist in Menu planning
- Prepare and serve meals under the supervision of a dietary manager.
- Set up tables in dining areas and delivers food to patients rooms.
- Clean food stations and wash dishes
- Deliver dishes and trays to assigned times and places
- Take down dining areas and collect plates, glasses etc.
- Monitor inventory on a daily basis , order and manage inventory
- Clean food stations and wash dishes
- Discard leftovers and take out the garbage
- Deliver dishes and trays to assigned times and places.
- Prepares snacks and helps / assist assigned cook in meal preparations .
Personal Assistant
The Fry\'s
London, England
01.2006 - 01.2010
- Arranged domestic and international travel plans and itineraries, including flight, car service and restaurant reservations, occasionally, traveling with the employer to look after or provide general assistance to their 8 year old son.
- Developed professional relationships with reliable vendors, including dry cleaning, tailors and designers.
- Coordinated and planned vacations for the family, Organizing and maintaining diaries and making appointments.
- Supervised 4 household staff, contractors and vendors.
- Transported children to and from school, activities and appointments.
- Maintained entire family\'s schedule and organized events.
- Screening phone calls, enquiries and request, and handling them when appropriate Dealing with incoming email, faxes and post , often corresponding on behalf of the employer.
CSR 3
Metropolitan Bank and Trust Company
Makati City, Philippines
07.1993 - 02.2003
- Answered an average of 30 calls per day by addressing customer inquiries, solving problems and providing new product information.
- Greeted customers entering the bank to ascertain what each customer wanted or needed.
- Answered product questions with up-to-date knowledge of sales and store promotions.
- Assist customers in opening new bank accounts, modifying existing accounts, completing paper work for products such as Certificate of Deposits.
- Provide direct service to customers by accepting deposits, cash checks and exchanging currency, receiving check orders from customers and providing traveler\\'s checks.
- Providing safe and secure storage of the cash fund, keeping each fund separate from the other funds or accounts.
- Replenishing the petty cash fund on or before the last day of each month if disbursement made and balancing each time minimum once a month.
- Notifying Central Bank of any changes in custodian, increases to fund, location of fund or changes in the physical of the fund.
- Ensuring that each transaction is allowable and for the purpose for which the fund was authorized.
- Reporting theft of funds or overages/shortages in accordance with the Head Office and Central Bank procedures and policies.
- Maintaining proper documentation and make prior arrangements foe a temporary custodian during any absences.
Education
Bachelor of Science - Business Management
University of the Assumption
City Of San Fernando Pampanga , Philippines1993
Skills
- Excellent time management skills
- Quick learner
- Strong client relations
- Training development aptitude
- Ability to deal with sensitive information and to maintain confidentiality at all times
- Can work extra hours to meet deadlines
- Exceptional interpersonal communication
- Honesty and reliability
- Attention to detail
- Ability to organized and plan own work
- Proficient in cash management
- Ability to work on own initiative
Timeline
Reconciliation Auditor
Elevance Health
09.2021 - Current
Membership Representative , Ind. E& B .
Anthem , Inc.
08.2019 - 09.2021
Customer Service Representative
Anthem, Inc.
07.2018 - 08.2019
Customer Service Representative
Teletech
09.2017 - 06.2018
Customer Service Specialist
Sutherland Global Services
10.2016 - 08.2017
Customer Service Assistant
Elite Lighting
01.2012 - 07.2012
Dietary Aide And Carer
Gentle Care Homes
02.2010 - 03.2011
Personal Assistant
The Fry\'s
01.2006 - 01.2010
CSR 3
Metropolitan Bank and Trust Company
07.1993 - 02.2003
Bachelor of Science - Business Management
University of the Assumption
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