E: ad38lu@r.postjobfree.com 813-***-**** A: Tampa, FL 33613

PROFESSIONAL SUMMARY

Passionate about promoting lasting customer satisfaction by delivering quality service and unparalleled support. Proficient in customer service best practices and related options. WORK HISTORY

Spectrum - Chat Support & Data Analyst

Remote

03/2020 - Current

Cognizant - Medical Claims Manager

Remote

07/2018 - 03/2020

Cyprexx Services - Senior Claims Examiner

10/2017 - 07/2018

SKILLS

EDUCATION

International Academy of Design

Institute

Tampa, FL

Chamberlain High School

Tampa, FL

High School Diploma

The Los Angeles Film School

Hollywood, CA

Associates Degree

Produced monthly reports using advanced Excel spreadsheet functions.

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Extracted and interpreted data patterns to translate findings into actionable outcomes.

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Responded to customer inquiries and provided accurate information about products and services via live chat.

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Handled inbound customer chat conversations from various websites.

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Documented all customer information accurately in computer system, providing dated notes for future reference.

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Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.

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• Determined proper course of action for claims processing. Documented and communicated timely claims information while supporting accurate outcomes.

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Handled claims consistent with client and corporate policies, procedures, best practices and regulations.

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Maintained strict confidentiality with all personal data as per company guidelines.

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Interviewed claimants and witnesses to gather factual information.

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Handled complaints and grievances using negotiating and problem-solving skills.

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• Read over insurance policies to ascertain levels of coverage and

• Inbound Customer Calls

• Information Updates

• High-Volume Call Centers

• Customer Service and Assistance

• Interdepartmental Collaboration

• Personnel Training and Development

• Effective Workflow Management

• Customer Relations

• Leading Team Meetings

• Continuous Improvements

• Account Resolutions

• Work Prioritization

• Microsoft Excel

• Quality Assurance Controls

• Superior Computer Skills

• Verbal and Written Communication

• Account Updates

• Collaborative Environments

HO / HIRAM ORTIZ JR

Cyprexx Services - Claims Associate

06/2014 - 10/2017

Stream - Billing and Collections Specialist

Tampa, FL

08/2013 - 06/2014

determine whether claims would receive approvals or denials. Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.

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Followed up on potentially fraudulent claims initiated by claims representatives.

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Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.

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Worked productively in fast-moving work environment to process large volumes of claims.

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Analyzed and addressed escalated claims to resolve issues quickly.

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Collaborated with internal departments and external vendors to achieve fast resolution of claims.

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Prepared and presented detailed reports to management on claims issues to aid in decision making.

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Prepared insurance claim forms or related documents and reviewed for completeness.

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Interviewed policyholders to verify information and obtain additional details.

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Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.

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• Negotiated to collect balance in full.

• Processed payments and applied to customer balances. Maintained high volume of calls and met demands of busy and productive group.

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Researched accounts and completed due diligence to resolve collection problems.

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Worked in call center environment handling manual and automatically dialed outbound calls.

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