Customer Service Claims Analyst
Resume:
Alondra Santos
Senior Claims Analyst
Contact
*******.******@******.***
***************@*****.***
Objective
Detailed driven employee, with a strong analytical mindset. A quick and adaptive learner, who is eager to leverage my customer-centric experience and existing skillset, to contribute towards company success. Education
Coronado High School
2013-2018
Scottsdale, AZ
Scottsdale Community College
2018-2019
Scottsdale, AZ
Key Skills
Time Management
Communication
Detail Oriented
Proficient in Microsoft Program
Problem-solving
Customer Service
Claims Analysis
Bilingual (Moderate Spanish)
Experience
December 2023 – Present
Lead Claims Auditor • Stealth Partner Group
• Handles escalations between the Admin, Carrier, Broker and Client.
• Consistently adaptive, to work towards optimal resolutions.
• Supervisory experience per a team of at least five individuals
• Provides consistent feedback and coaching to analysts as a team, as well as on an individual level, to address areas for development.
• Collaborates with leadership team, in conducting staff interviews.
• Conducts regular audits, while utilizing strong analytical skills to identify patterns, trends, and anomalies in claims data.
• Attends frequent internal meetings to promote ideas and provide feedback on collaboration and process improvements.
• Attends calls/meetings with both internal and external partners, as a claims subject matter expert.
July 2022 – December 2023
Senior Claims Analyst • Stealth Partner Group
• Conducted comprehensive analysis of insurance claims to determine eligibility, accuracy, and adherence to policy guidelines in order to obtain efficiency within the reimbursement process.
• Maintained an elevated level of accuracy and attention to detail, while handling complex claim inquiries and providing timely resolutions.
• Managed a senior level block of claims business, for 75+ client cases during a regular season and managed up to 90+ lines by 11/2023 to support my time due to abrupt staffing changes.
• Occasional assistance to lead with training and development per new hires.
• Utilized strong analytical skills to identify patterns, trends, and anomalies in claims data, contributing to process improvements. June 2021 – July 2022
Intake Coordinator • Stealth Partner Group
• Assisted in intake of 250+ Claims department emails per regular day and up to 1,000+ during a busy season, to be in accordance with timely processing guidelines.
• Assisted in data collection and organization to ensure accurate and up-to-date client information.
• Navigated through various portals to pull/analyze extensive reports and submissions, to forward to corresponding Claims Analyst.
• Logged between 10-100 checks daily and distributed to appropriate Claims Analyst.
August 2019 – June 2021
Claims Customer Service Representative III • Nationwide E&S
• Functioned as a liaison between customers and internal departments, to facilitate prompt resolution of issues and maintain customer satisfaction.
• Provided exceptional customer service, by addressing customer inquiries, concerns, and claims in a timely and professional manner.
• Efficiently communicated complex insurance information to customers, to ensure a clear understanding of policies and coverage. March 2019 – August 2019
Disney College Program Merchandise • Walt Disney World Resort
• Provided exceptional customer service by creating magical moments for Guests.
• Demonstrated in-depth knowledge of Disney products, services, and brand storytelling, to enhance the Guest experience.
• Executed merchandise displays, to create visually appealing product presentation and elevate the customer experience.
Leadership Highlights/SkillSet
• Lead and assisted in motivating a team of 7+ individuals in claims.
• Trained a series of new hires in the Claims Department on the life cycle of a claims and day to day responsibilities, as well as establishing expectations.
• Assisted with employee engagement, by hosting and assisting with hosting various events within PPC (Planning Party Committee), between 2021-2023 Including:
o Candy Apple Sales 2022, Candy Cane Grams 2022, Boo Grams 2022, Halloween Costume PowerPoint 2021-2022, Gratitude Wall PowerPoint 2021-2022;
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