Call Center Customer Service
Resume:
Nancy A. Espanol
Hartford, CT
************@*****.***
Skills & Abilities
Worker’s comp/auto claims and medical bill auditor supervisor. Proficient in analyzing claim data to identify trends, patterns, and opportunities for process improvement, contributing to the overall efficiency of the claims management process. Constant communication with various medical professionals, and legal representatives.
Experience
CorVel Corporation- Call Center Supervisor -Bill auditor 2021- Present
Supervise a team of 11 employees, ensuring service excellence in production, timeliness, and quality for bill auditing procedures in Auto and Workers' Compensation claims. Train and develop 7 customer service representatives and 3 bill review analysts, fostering continuous learning and professional growth.
Performance Management: Monitor and optimize team productivity through performance management, resolving challenges to enhance efficiency and service quality. Conduct quality assurance reviews of provider bills for Workers' Compensation and No-Fault claims, driving accuracy and adherence to standards. Time and Workload Management: Coordinate operational workflows to comply with timeliness standards for contact, follow-ups, and payments. Identify and respond to support requests across all team levels, ensuring seamless collaboration and resource allocation.
Claims and Financial Expertise: Possess advanced knowledge of CPT, ICD-9 coding, and NYWC Fee schedules within the CMS claims system. Investigate and resolve provider appeals and billing disputes, audit financial transactions, process check voids and apply credits to ensure accuracy in expense and vendor payments.
Operational and Strategic Support: Support the area Vice President with operations, including researching and calendaring arbitration requests for billing auditing purposes.
Collaborate closely with in-house counsel and customer attorneys to resolve complex billing issues for hearings and arbitrations. Emphasize purposeful communication, active listening, and flexibility to align team efforts with organizational goals. Plan and execute initiatives to enhance team productivity and achieve high performance levels while maintaining compliance with regulatory and company standards. This combination of leadership, operational expertise, and commitment to high-quality standards has driven success in claims processing, team development, and financial oversight.
Chubb & Son Insurance – Senior Claims Assistant (T360 Attorney Billing Admin) 2008-2021
Problem-Solving Expertise:
Applied broad-based analytical skills to resolve complex claim inquiries, ensuring efficient solutions in compliance with regulatory and company standards.
Claims Operations Management:
Oversaw claims correspondence and reporting for NY, NJ, PA, MA, and CT, including WC forms, acknowledgment letters, claim file documentation, and claimant details.
Administered WCIRS and the NYWCB Portal, managing hearing notices, Notices of Decision, and claims attachments to meet WCB guidelines.
Claims Administration:
Processed FNOL, SROI, claimant information, and claim status updates across multiple Chubb claims systems. Conducted audits of expense payments and vendor appeals, ensuring accuracy in financial and operational processes.
Financial Transactions Oversight:
Supported the T-360 E-Billing platform by reviewing financial transactions, addressing invoice feed errors, and processing WC DEPO fees.
Resolved rejected and suspended payment reports while managing Excel data exchanges to enhance workflow efficiency.
Collaboration & Communication:
Fostered effective collaboration with Chubb adjusters, attorneys, vendors, brokers, and external partners. Provided clear and empathetic communication with claimants, legal counsel, and physicians to resolve inquiries.
Insurance Expertise & Compliance:
Demonstrated expertise in Liability, Property, and Casualty Insurance, ensuring compliance with industry regulations.
Efficiently organized workloads to meet high-demand environments, supporting claims processing and audits with precision.
This combination of strong analytical, organizational, and communication skills ensured accurate claims handling and fostered positive relationships with stakeholders, aligning with company goals and industry standards
Education
Capital Community College – AS Political Science 2022-2025
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