Maribel Amor

***** ** ** *****, ***** Gardens, FL 305-***-**** adbfdv@r.postjobfree.com

Education

. MASTER’S IN SCIENCE, DECEMBER 1991, FLORIDA ATLANTIC UNIVERSITY

•Major: Biology

•Minor: Education

•GAP: 3.67

BACHELOR’S IN SCIENCE, APRIL 1983, FLORIDA INTERNATIONAL UNIVERSITY

•Major: Biology

•GPA: 3.10

ASSOCIATE ‘S IN SCIENCE, MAY 1980, LINCOLN LAND COMMUNITY COLLEGE

•Major: Biology

• GPA: 3.48

Skills and Abilities

Ability to work independently or in group format. Good ability to write, analyze reports and interpret data. Computer skills: Microsoft Office Workability, Windows, and good typing skills. Languages: Spanish (native) and basic French. Ability to handle and adjudicate complex disability claims. Knowledge of medical terminology and disease processes. Excellent customer skills. Certified and appointed with major insurance carrier to sell Medicare Advantage Plans.

Professional Experience

MEDICARE SPECIALIST, 03/2019 TO PRESENT

Sell Medicare Advantage plans/Supplements for major insurance carriers. Perform sell presentations, initiate contacts by phone and face to face. Appointed and certified to sell with Aetna, United Healthcare, Humana, Simply, Wellcare, and Cigna

SELF-EMPLOYED (PART-TIME)

TUT0R, 02/2016 TO PRESENT

Tutoring students in my house in the areas of math, and other subjects. I manage some properties with provide me with extra income. Drove for UBER from 10/2006 to 03/2018.

INSURANCE BENEFITS SPECIALIST, NOVA SOUTHEASTERN UNIVERSITY, 09/28/2015 TO 01/2016

Collaborates with multiple providers and payers to obtain proper authorization for different service levels; uses knowledge of payer requirements and medical coding to request authorization to determine if services are reimbursable.

Obtains pertinent documentation, i.e. history/physical, physician/progress notes, prescription, etc. to support the authorization request; interviews and assists patients with authorization documents.

Verifies benefits, insurance coverage, request authorizations, and obtains additional supporting medical documentation, whichever the patient's insurance dictates. Ensures payment for services by verifying benefits with insurance provider.

SENIOR DISABILITY BENEFIT MANAGER, AETNA LIFE INSURANCE COMPANY

Transferred to the centralized LTD (Long Term Disability) unit to handle seven (7) Aetna insured national accounts in October 2006. Major duties: issued timely payment, approvals/denials/terminations. Adjudicated claims by following ERISA regulations in the adjudication of new, active, and maintenance claims. Handled moderate to complex Long-Term Disability (LTD) claims. Issued survivor and death benefits. Accomplishments: remained timely on tasks despite multiple technical issues. Assisted the unit by providing examples of letters, edit-corrections of letters, templates, etc. Ability to make accurate and independent decisions. in charge of the Lumbermens project from 04/2009 to 11/2009, I received a score of 4/5 on my most recent evaluation. Mentored several members of the unit. Provided excellent customer service to internal and external customers. In September 2011, I audited the Dell account long term disability claims for financial errors and the outcome was that the external audit conducted by dell in October 2011 resulted in excellent scores. From 2010 to March 1, 2013, I handled three self-insured accounts and on March 1, 2013, I began adjudicating exclusively long-term disability claims for Dell. In November 2013, a new account was added (Boston scientific). I was nominated for the silver award in caring.

DISABILITY CLAIMS SPECIALIST III, BROADSPIRE SERVICES INC, 11/2003 TO 04/05/2006

Handling Main emphasis was to act as a leader in the adjudication of the BellSouth Long Term Disability claims. and assignment of complex Long-Term Disability Claims. Provide training, direction, and mentoring to other members of the BellSouth Long Term Disability Unit. Awarded Silver award for excellence in Customer Service. Issued approvals/denials/ termination as warranted under the contract/plan. Created templates for letters, in charge of completing the production report for the unit, and several monitoring documents. Aetna acquired Broadspire Services on 04/01/2006 but Business was handled under the umbrella of Broadspire until approximately October 2006.

DISABILITY CLAIMS EXAMINER II, Kemper National Services, 01/2000 to 11/2003

Manage and adjudication of complex Long-Term Disability Claims of disabled employees, Assessing Disability Pensions, Applying ERISA Principles and Regulations, obtaining medical data, analyzing medical and vocational data, submit correct forms. Above Average Performance. Responsible for developing and creating letters to be used by members of the unit. Customer Service Awards in 2004 and 2005. In charge of the production report, Hewitt report and other projects.

MEDICAL DISABILITY QUALITY CONTROL ANALYST, OFFICE OF DISABILITY DETERMINATIONS, 07/1998 TO 01/2000

Reviewed disability claims for accuracy at the initial, reconsideration, and continued disability reviews as outlined by the Social Security Administration. Provided training to members of the unit; stay within the approved budget for expenditures involved in the cost of obtaining consultative exams. Monitored and suggested strategies in the proper adjudication of disability claims. Adjudicated claims in both Title II and Title XVI for both children and adults by analyzing medical and vocational data and other pertinent information such as activities of daily living. I was promoted to the above position July 21, 1998. Awarded certificate for extraordinary case management on July 24, 1998. Adjudicated a large quantity of cases both accurately and timely.

ENVIRONMENTAL SPECIALIST, Florida Department of Health/environmental waste, 02/1997 to 06/1997

Performing inspections of facilities that generate biomedical waste, investigate biomedical waste complaints; use code enforcement to achieve compliance with Florida statutes. Review of biomedical waste protocols in each of the generating facilities.

BIOLOGY INSTRUCTOR, PART-TIME, MIAMI DADE COMMUNITY COLLEGE, 09/1994 TO 04/1995.

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