Camille Soto Alicea

Haines City, FL *****

ad4drg@r.postjobfree.com

+1-787-***-****

Dynamic, service-driven administrative professional adept managing multiple responsibilities in a fast paced environment where planning, organization, prioritization and communication skills are key. Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Appeals and Grievances Case Set up Specialist

Optum - San Juan, PR

August 2022 to Present

As a case set up specialist. We must use critical thinking in order to determine if an appeal, a grievance or disputed claim received from a provider or subscriber can be considered for a reconsideration or the payments or rejection of claims.

Member Engagement Representative

TRIPLE S ADVANTAGE - San Juan, PR

June 2015 to August 2022

Make outbound calls to all of our Health care plan members to complete different types of surveys as cancellation, disenrollment, follow up and quality based on their experienced such as help them with their inquiries, complaints, grievances and fulfill their needs with excellent customer service following the Center for Medicare and Medicaid Services standard procedures reaching 100 % percent of quality in every call.

Complete changes of health plan coverages during the Annual Enrollment Period and in Open Enrollment Period, work with providers claims, disputes, appeal and grievances procedures. Customer Service

Humana Medicare Health Care a XEROX ACS company - Guaynabo, PR June 2012 to May 2015

Work in fast paced environment receiving calls of our English speakers customers living in the United States; help them with their inquiries, their grievances and appeals and invoices claims, taking payments and reaching 100 % percent of quality in every call. Telemarketer

Gran Melia Hotel Vacation Club - Río Grande, PR

December 2008 to April 2012

Promote vacation club program via cold calling and telemarketing activities. Qualify prospects and offer them attractive vacations. Constantly overcome the monthly production. Achievements

2008 Top Sales Telemarketing

Education

Bachelor Degree in Social Science

Universidad de Puerto Rico Recinto de Río Piedras - Rio Piedras, PR January 1997 to June 2003

Associate Degree in Secretarial Science

Colegio Universitario de San Juan - San Juan, PR

January 1994 to December 1996

Skills

• Fully bilingual English and Spanish, knowledge and domain of Microsoft Programs Word, Excel and Power Point. Typing skills 60-75 word for minutes. (10+ years)

• Triage

• Cold Calling (10+ years)

• Telemarketing (10+ years)

• Administrative Experience

• Computer skills

• Communication skills

• HIPAA

• Typing

• Customer service

• Microsoft Access

• Windows

• Sales

• Data entry (9 years)

• Bilingual

• English

• Spanish

• Microsoft Office

• Retail sales

• Hotel experience

• Medical terminology

• Administrative experience

• Medical office experience

• Organizational skills

• Phone etiquette

• Office experience

• Cold calling

• Cash handling

• Guest services

• Restaurant experience

• Cash register

• Microsoft Excel

• Computer networking

• Analysis skills

• CRM software

Languages

• Spanish - Fluent

• English - Fluent

Certifications and Licenses

Camille Soto

September 2020 to August 2026

Driver's License

September 2020 to August 2026

Additional Information

Got promoted in Optum from Appeals and Grievances for Medicaid to Behavioral Health Appeals and Grievances on November 6 2023. Knowledge in Facets, Macess, Icue, Linx, Iset, Aset and ETS.

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