Yahaira Diaz-Reyes
Deltona,FL
Summary
Professional with strong background in customer relations, adept at resolving complex issues and enhancing client satisfaction. Skilled in communication, problem-solving, and time management, ensuring seamless service delivery. Collaborative team player, adaptable to changing requirements, self motivated and self starter, consistently driving results and fostering positive work environment.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Customer Service Specialist III
ASM Research - Part of Accenture Federal Services
11.2022 - Current
- Intake, identify, review and triage high complexity inquiries.
- Provide complex support and resolution for highly complex inquiries, including coordination and outreach with providers, different stakeholders, and CMS groups.
- Provide highly specific and/or advanced instructions to providers, health care facilities, insurance companies or insurance plans; and/or other entities as directed by CMS.
- Conduct comprehensive inquiries for CMS, ensuring HIPAA compliance and safeguarding sensitive health information during issue resolution.
- Building lasting relationships with clients and other call center team members based on trust and reliability.
- Utilizing software, databases, scripts, and tools appropriately.
- Understanding and striving to meet or exceed call center metrics while providing excellent consistent customer service.
- Adhering to all company policies and procedures.
- Develop, own, and maintain internal OST User Guide and lead new hire training, conduct peer reviews on team members’ work, improving onboarding efficiency and reducing knowledge gaps by 20%.
Claims Adjuster Representative I
Liberty Mutual and Safeco Insurance
03.2022 - 11.2022
- Identified and escalated fraud cases, improving detection and recovery.
- Ensured secure handling of sensitive financial data, collaborating with legal and risk teams.
- Communicated with policyholders, and claimants to gather information regarding claims, referred tasks to auxiliary resources as necessary, and advised as to proper courses of action.
- Resolved claims with 98% accuracy, minimizing risk through detailed investigations.
Talent Acquisition - Sourcing Specialist
JPMorgan Chase
09.2021 - 03.2022
- Developed and executed full-cycle recruitment strategies to attract top talent.
- Maintained confidentiality of candidate data, contributing to data protection compliance.
- Streamlined recruitment reporting, increasing operational efficiency.
- Analyzed hiring metrics to improve recruitment strategies and reduced time-to-hire by 20% through effective market analysis and process improvements.
Business Analyst Specialist III
JPMorgan Chase
05.2020 - 09.2021
- Monitored control logs daily to oversee adherences to company policies and procedures and updated daily segment adherence forms with taken sick, vacation, PTO times using a coding method.
- Developed a new time-tracking template, enhancing real-time data access for leadership.
- Collaborated with teams to ensure compliance with updated regulatory standards.
- Led system training updates, reducing onboarding time by 25% and improving accuracy by 30%.
Credit Card Collections Specialist III
JPMorgan Chase
07.2019 - 05.2020
- Collected and evaluated card member accounts for hardship programs while attempting to collect the amount due on past due accounts.
- Provided escalation support for complex issues, maintaining regulatory compliance.
- Collaborated with legal and risk teams to resolve high-risk cases.
- Reduced delinquency rates by 20% through improved collections strategies.
Provider Services and Intake Representative
Healthfirst
06.2017 - 07.2019
- Resolved complex provider issues during inbound and outbound calls for follow-up on claims and authorizations for health facilities and individual providers, identified, directed, and/or researched provider issues in a timely resolution and transferred to appropriate departments for further required needs.
- Started authorizations and emailed assigned case managers to request for changes on an existing authorization.
- Improved claim authorization accuracy by 25%, ensuring full HIPAA compliance.
- Trained team leaders on new systems, reducing errors by 15%.
Education
Associate's Degree - Occupational Behavior Management
Ashford University
San Diego, CA01-2027
Skills
- Customer Service Excellence
- Excellent written and oral communication
- Data Analysis and Reporting (Excel, Salesforce)
- Cross-Functional Collaboration (Legal, HR, Risk)
- Risk assessment and Mitigation
- Microsoft Office Suite, Workday, KBA, Deltek
- Complaint Resolution
- De-escalation techniques
- Microsoft Office Suite
- Computer proficiency
- Active listening
- Building rapport
- Privacy/Compliance (HIPAA, CMS Regulations)
Certification
- Certified Claims Adjuster
Timeline
Customer Service Specialist III
ASM Research - Part of Accenture Federal Services
11.2022 - Current
Claims Adjuster Representative I
Liberty Mutual and Safeco Insurance
03.2022 - 11.2022
Talent Acquisition - Sourcing Specialist
JPMorgan Chase
09.2021 - 03.2022
Business Analyst Specialist III
JPMorgan Chase
05.2020 - 09.2021
Credit Card Collections Specialist III
JPMorgan Chase
07.2019 - 05.2020
Provider Services and Intake Representative
Healthfirst
06.2017 - 07.2019
- Certified Claims Adjuster
Associate's Degree - Occupational Behavior Management
Ashford University
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