Summary
Overview
Work History
Education
Skills
Timeline
Generic

Vanessa Zavala

Oxnard,CA

Summary

Results-oriented Customer Service Professional who excels at uncovering Customer needs, finding solutions and handling objections. Top performer with a consistent track record of meeting and exceeding goals.

Overview

12
12
years of professional experience

Work History

Provider Services Representative

Optum / Seaview IPA
08.2019 - Current
  • Assisted in the design and implementation of programs that build/nurture positive relationships between the IPA, providers, and practice managers.
  • Assisted in end-to-end provider claims, authorizations, provider contract interpretation and help enhance call quality.
  • Assisted in testing and implementation of new functions to Ez-cap and Ez-net system to improve operational efficiency.
  • Performed on-site visits to new provider offices to ensure readiness and compliance.
  • Followed up with customers about resolved issues to maintain high standards of customer service.
  • Consistently monitoring and managed the provider roster, ensuring timely follow ups, and maintenance.
  • Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
  • Cross-trained existing employees to maximize team agility and performance.
  • Led onboarding training for all new hires within the Provider Relations department.

Client Advocate

Beneflex
02.2015 - 02.2018
  • Serve as a client's advocate with the insurance companies/providers. Negotiates on a client's behalf in areas such as disputed claims, contract interpretation and administrative issues.
  • Enter applicable changes at renewal or if changes occur throughout the year. Interfaces with client employees during Benefits open enrollment to aid in online enrollment process. Client enrollment and termination processing. Provides support with Benefit Changes.
  • Act as an extension of client's HR Department with questions and concerns regarding their benefits, including, but not limited to quick answers to claim questions and status, clarification of benefits for clients, deductible and copay information, medical referral procedures, assistance locating Participating Providers.


Broker Services Coordinator

Anthem
08.2013 - 01.2015
  • Investigated and resolved issues with outstanding balances.
  • Followed up with customers on unresolved issues.
  • Calculated quotes and educated potential clients on insurance options.
  • Tracked the progress of all outstanding insurance claims.
  • Calculated premiums and established payment methods for sales.
  • Collected all premiums on or before effective date of coverage.
  • Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
  • Coordinated and conducted employee orientations to promote understanding of coverage and options.
  • Implemented open enrollment system to streamline benefits processes for members.

Education

Associate of Science - Medical Billing And Coding

Charter College
Oxnard, CA
2012

High School Diploma - undefined

Vista Real Charter High School
Oxnard, CA
2006

Skills

  • Provider Onboarding
  • Regulatory Compliance HIPPA & CMS
  • Client Relationships
  • Code validation skills
  • Calm and Professional Under Pressure
  • Self-motivated
  • Team liaison
  • Site Visits
  • Strong verbal communication
  • Data analysis
  • Medical terminology knowledge
  • Claims processing
  • System Implementation & Testing
  • Virtual training

Timeline

Provider Services Representative

Optum / Seaview IPA
08.2019 - Current

Client Advocate

Beneflex
02.2015 - 02.2018

Broker Services Coordinator

Anthem
08.2013 - 01.2015

High School Diploma - undefined

Vista Real Charter High School

Associate of Science - Medical Billing And Coding

Charter College

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