Vanaequa Malave Guzman

• Investigated and resolved client-reported fraud claims with a focus on accuracy and compliance.

• Reviewed financial transactions, analyzed claim details, and escalated findings when appropriate.

• Collaborated with internal departments to assess risks and ensure quality customer service.

• Documented findings and maintained detailed records in internal CRM systems.

• Demonstrated strong communication skills while interacting with customers over the phone, via email, or in person.
• Assisted with training new employees on the company’s procedures for handling customer inquiries.
• Employed active listening techniques to understand customers’ needs and provide appropriate solutions.
• Handled escalated calls professionally while providing a positive resolution for the caller.
• Educated member on benefit enrollment choices and what each plan offers.
• Scheduled yearly wellness visit for member.
• Investigated prescription refill denials.

• Verifying insurance eligibility and handling billing processes.
• Scheduling appointments and managing patient flow.
• Registering patients and updating medical records.
• Hiring and training administrative staff.
• Assigning tasks and monitoring staff performance.
• Scheduling staff shifts.
• Managed daily tasks such as photocopying, scanning documents or sending faxes on behalf of staff.
• Maintained confidentiality regarding all personnel matters within the organization.
• Reviewed invoices prior to submission; verified accuracy of billing details before payment processing.