Noel J. Diaz

**** **** ***

Cleveland, OH *****

Mobile Phone: 717-***-****

E-mail: aceqnq@r.postjobfree.com

OBJECTIVE

To obtain a position in a related field where my skills and experience will

be utilized at its highest potential.

WORK EXPERIENCE

Bilingual Call Center Supervisor PHEAA

Harrisburg, PA

Nov 2013 - May 2014

* Develop and manage a high performance team of representatives that may

respond to, anyone of the following, lenders, guarantors, administrators,

and/or customer inquiries; both verbally and in writing.

* Develop and enhance employee competence and effectiveness by providing on-

going guidance, mentoring, feedback, and motivation to staff to ensure

competent performance and succession planning while adhering to department

and PHEAA policies and procedures.

* Responsible for interviewing candidates, hiring, writing and delivering

annual performance evaluations, promotions, and terminations as necessary.

This includes monitoring attendance; leave requests, FMLA usage, time

sheets to ensure accuracy of hours worked and adherence to Agency and

business units' policies and procedures. Responsible for all on boarding

department new hires training.

Call Center Supervisor Med D Benecard PBF

Mechanicsburg, PA

Aug 2012 - Nov 2013

* Responsibilities create, edit and maintain Policies and procedures.

Assist in writing business requirements. Routine monitoring of call metrics

such as Abandonment Rate, Average Speed of answer and Service Level.

Provide coaching and feedbacks to CSR, conduct Quality Assurance monitoring

and scoring.

* Develop and enhance employee competence and effectiveness by providing on-

going guidance, mentoring, feedback, and motivation to staff to ensure

competent performance and succession planning while adhering to department

and Medicare policies and procedures.

* Recruit, mentor, and execute supervisory duties including identifying

problems with performance and solutions to those problems. Determine

training needs to improve performance, initiating informal measures to

correct misconduct or making recommendations for formal discipline based on

HR policies. Conduct annual performance reviews for team members and other

duties as assigned.

Provider Systems Administrator Coventry Health

Harrisburg, PA

Sept 2010 - Aug 2012

*Responsible for coding and building provider demographic and payment

information and/or client provider network information into the

transactional system and other databases.

*Extracts date from the transactional system for analysis and system set-

up. Facilitate resolution of provider, group, or contract related claims

users.

*Supports accurate claims auto-adjudication and accurate claims payment.

*Supports Information Administrators in servicing health plans and customer

service/claims by providing data used to develop new products and

strategies. Acts as an interface between health plans and customer

service/claims.

*Provide support to the health plan and customer service/claims department

regarding system capabilities and limitations.

Medicare Insurance Analyst EDS/ HP Camp Hill,

PA

June 2005 - Sept 2010

*Investigate Medicare Complaints and/ or Fraud for the state of Florida and

Puerto Rico & Virgin Islands. Research complaint form, medical records and

HIPAA documentations and create reports for provider, beneficiaries, or any

entity for Medicare.

*Communicate and assist various law enforcement and CMS for the state of

Florida and Puerto Rico & Virgin Islands.

*Request and review medical records based on interpretation of complaint/

fraud. Participate in cross-functional user groups to optimise the use of

the existing transactional systems and reports.

OPL Specialist (Coordination of Benefits) Capital Blue

Cross Harrisburg, PA

Aug 2004 - June 2005

*Responsible for utilizing multiple automated systems/files and working

with customers, group administrators, professional and facility providers,

attorneys, Plan and Par Plan personnel, and other insurance carriers and

outside entities to ensure the satisfactory resolution of COB inquiries and

claims in an efficient, professional and accurate manner.

*Responsible for meeting BCBSA MTM standards for customer service inquiry

accuracy and timeliness; claims processing accuracy and timeliness; and

Account Savings benchmarks.

Adjustment Examiner

Jan 2003 - Aug 2004

*Code and enters data received from subscribers and providers for expense

submitted under the terms of Facets contracts using the Image System and

Facets Claims Processing System.

*Reviewing, adjusting and processing Facets claims that are in a pended

status through interpretation of warning messages and instructions in

accordance with processing procedure, Facets policies and current contract

specifications regarding coverage, contract limitations, and exceptions.

*Doing refund for providers and subscriber who return dollar amount to be

correct or has been requested by examiners.

Customer Service Rep

June 2002 - Dec 2002

*Assist customer with their medical benefits, along with office assistant

from provider's office with claims and payments.

* Adjust claims due to various payment corrections and inquiries in-between

calls and downtime.

Bi-Lingual Dental Customer Service United Concordia Company

Harrisburg/Pa

June 2000 - May 2002

* Bi-Lingual representative for various accounts assisting customers and

Dental office assistants with dental benefits, claims and payments.

* Adjust claims due to various payment corrections and inquiries sent to

UCCI in-between calls and downtime.

Sales/ Bi-Lingual Customer Services Rep Stanley Staffing

Services Cleveland/Ohio

Dec 1998- June 2000

* Worked on various temporary projects for different companies. Sprint PCS,

Household Bank, AOL, Hartland Home Finance & Collection Agencies.

* Answering incoming calls, outbound calls, handled third party

verifications, schedule and handled all aspects of sales and customer

service calls, also processed loan applications. (Approximately 90-100

calls per day.)

Warehouse Lead/ Assembly/ Punch Press Mr. Gasket Co

Cleveland/Ohio

Feb 1996 - Dec 1998

* Assembly, packing, machine operator, picking order for car racing parts

company. Driving Forklift to move products the warehouse.

* Warehouse Lead doing different types of jobs like ordering stock parts,

assisting employees and training them, assigning work to warehouse

employees. Knowledge of UPS, FedEx, Airborne and truck BOL.

EDUCATION

Institute of Banca & Data Ponce, Puerto Rico

Associate Degree 1996- Drafting/Auto CAD

Ramon J. Davila High School Coamo, Puerto Rico

General/Drawing courses- 1994

SKILLS

Bilingual/ Spanish- Expert

Microsoft Office- Intermediate

REFERENCES

Andrew Primrose- Server/ 717-***-****

Linda Rasmussen- Insurance Analyst HP/ 717-***-****

Victor Martinez- PSA Administrator/ 717-***-****

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