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.