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Work experience

June 2017Present

Claims Adjustment Rep.

United Health Group
  • To review and research  claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing 
  • To complete necessary adjustments to claims and ensures the proper benefits are applied to each claim by using the appropriate processes and procedures
  • To complete reports on a daily basis while maintaining all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements
  • To review medicaid related claims and to execute them according to their corresponding benefit plan and contractual amount
  • To review medical records and provider agreements in accordance to corresponding denial or approvals.
  • To utilize Decision Trees in accordance with company policy and rules and regulations as needed to govern all claims in a regulatory manner.
  • To work as a individual contributor and to follow and to adhere to the rules and regulations implemented by medicaid and other assigned states.
  • To analyze and to execute multiple projects from excel into multiple databases to ensure proper reporting and regulatory standards are met.
  • To maintain reporting measures for TX Skilled Nursing Facility projects and to communicate any changes or findings to management in accordance to established guidelines and procedures.
October 2016June 2017

Associate Administrative Clinical Coordinator 

United Health Care
  • To  analyze inbound calls such as provider  inquiries and claims questions.
  • To process and analyze calls in regards to authorization requirements such as inpatient stays and behavioral health cases.
  • To utilize decision trees in accordance with the authorization requirements and the company guidelines and regulations to approve or deny clinical cases.
  • To process incoming member requests from Employment Retirement Systems(ERS) including benefit changes and inquires as well.
  • To process all faxes including explanation of benefits and policy changes and authorization approval letters and correspondents to providers and members in accordance with company policies and procedures .
  • To process  and execute inquiries for the plan such as claims inquiries and payment amounts and even provider contracting  payments.
  • To process any changes to providers EFT information for payment purposes and to review all complex issues in regards to claim discrepancies and to resolve accordingly.
  • To review cases and to analyze for medical necessity while reviewing authorization requirements for medical consults and other professional services and all inpatient levels of care.  
April 2016October 2016

Behavioral Health Advocate I

Blue Cross Blue Shield
  • To maintain communication with management regarding developments within areas of assigned responsibilities and perform special projects as required or requested.
  • To maintain liaison with in-house areas regarding groups’ concerns, e.g. Marketing, Provider Affairs, and SSD.
  • To route cases appropriately pursuant to the workflow for clinical review or to other departments as necessary.
  • To collect clinical data using appropriate clinical data screens and enter information into the system.
  • To process or pend for clinical review certifications/authorization requests according to established policies and procedures from the work queue. To select contract eligibility, as it relates to precertification and/or referral authorization requests based upon information provided by hospital personnel, members, and providers.
  • To review/respond to service requests from incoming calls, faxes/Images, recorded voicemail messages from hospitals, providers, and members. Inquiries include referral request current and retro from PCP to specialist, and authorization requests for in and outpatient treatment. Assist members including explaining the different types of behavioral health providers and the services they provide.
February 2015April 2016

Mutual Funds Associate (Contract)

State Farm
  • To process and execute transactions according to market based trends. To ensure remarkable customer service is given while preserving account integrity.
  • To process and review transactions for accuracy based on market trends and compliance guidelines.
  • To maintain all account maintenance on mutual fund accounts according to company policy and market guidelines.
  • To maintain product knowledge of current market trends in order to ensure transaction compliance.
Octoober 2014February 2015

Customer Service Supervisor(Seasonal)

Burlington Coat Factory
  • To plan and coordinate multiple tasks throughout the day to ensure all associates are at maximum productivity.
  • To ensure that each associate is adhering to scheduled breaks and lunches accordingly.
  • To supervise each associate and to ensure that all tasks are completed by each associate by the end of work day.
  • To Prepare the daily schedule for each associate according to policies and procedures.
  • To ensure that each customer service associate is delivering an exceptional customer service experience.
  • To ensure that all metrics and customer service surveys are being met on a individual basis and store wide basis.
  • To Communicate with other departments and management to resolve problems and expedite work.
  • To Resolve complaints and answer questions of customers regarding services and procedures.
October 2013-March 2014

Training & Development/Escalations Specialist 


To analyze client issues and implement solutions that are client specific according to established modules.

To provide exceptional customer service at all points of interface. To process multi-step transactions in accordance to established guidelines.

To review insurance claims and to assist in correcting eligibility issues.

To  assist both doctors and pharmacist in their daily operation by facilitating procedural transactions including prior authorizations.

To Provide coaching and call support to associates. To Handle and resolve customer complaints and issues.

To monitor and evaluate agents on quality assurance measures and practices and procedures in accordance with company guidelines. 

To monitor productivity standards of all team members and to make business determination in accordance with business needs.


June 2017Present

Bachelors of Science in Public Administration

University of Phoenix
August 2015June 2017

Associates of Arts with a concentration in Health Administration

University of Phoenix
August 2009May 2012

High School Diploma

Sherman High School