Imelda Soto

ad4933@r.postjobfree.com 714-***-****

Effectively manages multiple, high-priority tasks while taking personal pride in providing excellent service.

• Fluent in Spanish (written and oral communication)

• Thorough review of medical records, benefit eligibility, account information, insurance policies and contracts

• Risk Assessment and Mitigation

• Evaluation of liability for insurance claims

• Comprehensive quality assurance reviews

• Detailed executive reporting

• Written and oral communication with doctors, attorneys, employers and claimants

• Claim investigation skills

• Compliance with state and federal laws and statutes

• Meets service level agreements

• Excellent Inter-departmental

collaboration

• Outstanding interpersonal relationship

skills

• Policy Interpretation

• Confidential Records Management

• Medical terminology

• Exemplary customer-focused catastrophe

assistance

• Microsoft Word, Excel, Outlook,

QuickBooks, VersaPay, Claim adjudication

systems

Employment History

EBA&M Irvine, CA 2014-2024

Accounting Support Assistant. Managed all Accounts Receivable transactions. Provided monthly income report information. Processed Accounts Payable via ACH and manual checks. Mitigated invoice and payment issues. Prepared broker commission payments and statements. Generated client-specific invoices and reports. Mail Center Administrator and Claims Coordinator for an outside business partner. Provided all mail-center support for company along with categorizing claims for distribution and ensured that claims were documented properly and gathered additional information as required; Customer Service Representative for self-funded employer groups, medical providers and claimants. Provided claims status updates coverage explanations. Worked with claims management to resolve disputes. Contracted Employee 2012-2014

Dell Software Inc – Aliso Viejo CA Accounts Receivable Responsible for resolving customer inquiries and account disputes, processed 300-400 daily invoices billed customers online on multiple customer websites, issued W-9 forms.

Zenith Insurance Company – Orange CA Claims

Contacted employers, doctors and injured workers to confirm details of the loss, updated information on paperless system, authorized payments, worked daily diaries, assisted other examiners as assigned. Global Benefits Group – Foothill Ranch, CA, Accounting Assisted on a 1099 project that included provider verification and tax preparation. Bank of America Insurance Services – Irvine, CA Mortgage Claims Specialist, 2008-2012 Adjudicated Mortgage Life, Platform Term Life, and Mortgage Catastrophe insurance losses in support of Bank of America mortgage clients. (Transfer due to Bank acquisition of Countrywide Insurance Group) Countrywide Insurance Group – Irvine, CA Claims Examiner III, 1999-2008 Adjudicated Life, Disability, Unemployment, Graded Premium, Debt Cancellation, Accidental Death and Dismemberment claims.

(Transfer due to Countrywide’s acquisition of Balboa Insurance Group) Balboa Insurance Group – Irvine, CA Customer Service Rep and Claims Examiner, 1989-1999 Customer service and claims assistance for Credit Life, Disability and Unemployment for credit card and loan customers for independent insurance entities.

Education

AA Degree, Liberal Arts, Fullerton College

REFERENCES AVAILABLE UPON REQUEST

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