Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Victor Rancor

Katy,TX

Summary

Detail-oriented Internal Auditor with well-established knowledge of control process validation. Trained in audits and known for great attention to detail, exemplary auditing skills, and commitment to excellence.

Overview

5
5
years of professional experience

Work History

Grievances and Appeals Auditor 1

Elevance Health
Houston, TX
04.2023 - Current
  • Analyzed system data and prepared reports outlining findings and recommendations.
  • Conducted risk assessments to identify potential areas of non-compliance.
  • Identified discrepancies in documents and processes, investigated causes, and proposed solutions.
  • Performed regular reviews of the company's operations for compliance with laws and regulations.
  • Assisted in preparing audit plans based on established objectives and standards.
  • Developed strategies to assess operational efficiency and effectiveness across specific departments.
  • Provided guidance on improving internal controls over business processes.
  • Maintained open communication with external auditors regarding coordination of audits.

Grievances and Appeals Specialist

Elevance Health
Houston, TX
04.2020 - 04.2021
  • Coordinated with internal departments to ensure timely resolution of grievances.
  • Identified trends in the types of grievances received, and reported those findings to management.
  • Maintained up-to-date knowledge of applicable laws, regulations, policies and procedures related to grievances processing.
  • Researched complex cases involving multiple parties or multiple issues to provide accurate decisions on appeals.
  • Collaborated with provider relations staff to resolve disputes between providers and health plans concerning payment for services rendered.
  • Ensured all documents are stored securely according to HIPAA standards.

Bilingual Customer Service Representative

Elevance Health
Houston, TX
10.2019 - 01.2021
  • Responded to customer inquiries in both English and Spanish languages, providing accurate information about products and services.
  • Provided translation assistance for customers with limited English proficiency.
  • Resolved customer complaints in a professional manner while adhering to corporate policies and procedures.
  • Processed orders accurately and promptly, ensuring timely delivery of goods and services.
  • Utilized multiple computer systems to access customer accounts, process payments, update account status.
  • Took ownership of each call by listening attentively to understand individual needs.
  • Ensured compliance with applicable laws and regulations related to customer service duties.
  • Updated databases with new and modified customer data.

Medicare Customer Service Trainer

Elevance Health
Houston, TX
04.2020 - 08.2020
  • Developed and implemented customer service training plans and objectives.
  • Conducted assessments of team members to identify areas for improvement in customer service skills.
  • Provided guidance and feedback to employees on how to improve their customer service skills.
  • Maintained detailed records of employee performance during customer service training sessions.
  • Assisted new hires in understanding the company's products and services as well as its mission statement and vision.

Education

GED -

Cy-Springs High School
Katy, TX

Skills

  • Audit Coordination
  • Report Writing
  • Record examination
  • Audit Planning
  • Sampling techniques
  • Internal Auditing

Languages

Spanish
Professional

Timeline

Grievances and Appeals Auditor 1

Elevance Health
04.2023 - Current

Grievances and Appeals Specialist

Elevance Health
04.2020 - 04.2021

Medicare Customer Service Trainer

Elevance Health
04.2020 - 08.2020

Bilingual Customer Service Representative

Elevance Health
10.2019 - 01.2021

GED -

Cy-Springs High School
Victor Rancor