Care Coordinator Claims Adjuster
Resume:
Karol Reyes
**** ******** **. #**** ******, TX **228
*********@*****.***
Bilingual: English/Spanish
OBJECTIVE
To obtain a position in a challenging and energetic environment that will utilize my 10+ years of customer
service experience and excellent communication skills.
EDUCATION
Remington College – Dallas, TX 08/2015
Associates of Applied Science for Business Administration
SKILLS
●Microsoft Office Word 2010 Certified Specialist
● Bilingual: English/Spanish
●Honest, Reliable, Responsible
●Team Player
●Exercise independent judgment
●Strong communication skills
●Strong organizational skills
WORK EXPERIENCE
●CPR Insurance
Claims Adjuster Assistant 08/2017- 03/2020
High volume incoming and outgoing calls, confirmed insured or claimants’ concerns and demographics in regards vehicle’s damages and location. Scheduled inspection date with inspector and owner of vehicle.
Followed up with Inspectors in regards schedule visits and photos obtained of the damages.
Updated spreadsheet and invoices.
●Care Options for Kids
Processing Coordinator 05/2017-07/2017
Daily referral process, confirm patient’s eligibility, confirm with the patients’ parent concerns and demographics. Prepared documentation for MD to review and sign and send off to payer source for authorization. Daily clinical follow up calls and parental follow ups to confirm documentations pending signature or parental action required.
●Sage Care Therapy
Plan Of Care Coordinator 05/2015 02/2017
Prepared clinical documentation that required clinical review from both pediatrician and health
insurance. Scheduled visits for patients accordingly to authorizations received from payer source. Would
follow up with clinics regarding pending documentation that required MD signature. Daily follow up
calls with health insurance that were pending authorization.
●QT Kitchen
Commissary 08/2014- 04/2015
Job varied depending on assigned position for the shift.
Production line: Were to be detail oriented, and able to maintain a consistent fast pace while making fresh food for QT stores on the daily basis. Communication was a must when running low on items and had to let a recharge know so production wouldn't stop.
Recharge: Were to to keep up with the need of the food items required by the production line by bringing in pallets with an electric pallet jack and or asking assistance from a certified forklift driver with pallets. A recharge would make sure each employee working the line had their bins filled with the proper item. Item was to keep running in the conveyor belt into a machine for packaging and labeling.
Catcher: Were to be prepared with pre-made boxes for incoming items and putting the right quantity of the food item per box and label the boxes as well. All while keeping up with making boxes to keep up with incoming production. Once boxes were ready, they were to be placed onto a pallet and wrapped for shipping. Once production goal was met everyone was to wash and sanitize entire room (conveyor belts, bins, machine operated equipment, floors, walls etc).
●Sam's Club
Accounting Associate 04/2011-05/2013
Prepared supporting documentation and posted journal entries to computerized accounting software,
maintained accounts in computerized data base and compiled reports, computed and recorded
charges, refunds, and adjustments Prepared vouchers, invoices, account statements, reports, and
other documents, reconciled accounts receivable and general ledger accounts, resolved customer
billing discrepancies and communicated with managers, supervisors.
●Sam’s Club
Cashier 12/2010- 04/2011
Greeted customers in a friendly and courteously manner while processing transactions Handled
customer questions on products and services.
●RPC Company Addison, TX 07/2012 – 08/2012
Verifier (HMS)
Responsible for the timely verification of medical insurance benefits, called private insurance
companies, Medicare, and Medicaid to obtain benefit information, determined insurance
compatibility with health care provider programs, updated and refiled claims, coordinated with
patients regarding their insurance benefits and medical providers programs, determined if an
insurance benefit plan considers selected products appropriate based on patient need
●U.S. Census Dallas, TX
04/2010 – 07/2010
Enumerator
Conducted research on behalf of the U.S. Census Bureau, reviewed the assigned field and prepared an
efficient route, traveled to designated households and conducted interviews with residents,
responsible for verifying household addresses and ensuring that all maps and address lists are correct,
corrected any discrepancies in the existing census data, collected household and demographic
information, appropriately documented and report the results of the finding, as well as documentation
of hours, miles and expenses encountered
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