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Cgi - Cosmetologist Resume Example

Taerlbo Lcelabo
XXXX XXXXXXXXXX XXXXX, San Antonio, TEXAS 78250
Ph: XXXXX XXX XXXX
XXXXXXXXXXXXXXXXXXXXXXX
Professional Summary

Responsible business professional proficient in claims processing and claims auditing. Passionate and motivated with a drive for excellence. 17 years in customer service and sales positions.

Skills
  • Time Management
  • Complex Problem Solving
  • Judgment and Decision Making
  • Negotiation
  • Auditing
  • Quality Control Analysis
  • Training / Mentoring
Experience
Medicare Appeals Specialist (Caseworker II / SME) Mar 2015Current CGI
  • Support the recovery of Medicare funds from No-Fault (NF) insurers and Workers' Compensation (WC) entities when these Group Health Plans (GHP) or Non-Group Health Plans (NGHP) report financial accountability ahead of Medicare. 
  • Use critical researching skills to determine the nature of appeals and correspondence from employers, Group Health Plans and Non-Group Health Plans, ensure adherence to Standard Operating Procedures (SOPs) to determine the next step. 
  • Evaluate medical claims documentation and coverage policy documentation to determine validity of the appeal.
  • Cultivate business relationships with GHP and LGHP liasons. Answer incoming queries via telephone, email, and hard copy.  
  • Accurately apply payments, and adjustment to accounts receivable
  • Facilitate new-hire training from classroom theory to practical execution of appeals processing.
Quality Control Specialist Sep 2013Dec 2014 Wells Fargo
  • Assisted with performing quality reviews for the Consumer Financial Protection Bureau auditing team and non-default mortgage processing team to ensure regulatory procedures are upheld.
  • Reviewed department processes to identify non-value added tasks and analyzed audit reports to identify trends with inaccuracies in processing. 
Claims Representative Associate May 2012May 2013 United Healthcare
  • Responsible for handling incoming medical claims ensuring a high level of customer service and maximizing productivity. 
  • Provided expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims. 
  • Familiar with Universal codes and terminology such as CPT4, HCPCS, Revenue and ICD-9 diagnosis and procedure codes.
  • Analyze and identify trends and provide reports as necessary while meeting established productivity and quality standards.
 
Independent Insurance Agent Oct 2007Oct 2011 Cabello Insurance Agency
  • Group1 - Life & Health licensed. Primary focus is the senior market for Medicare Advantage Plans, Medicare Supplement and Part D plans. 
  • Marketed and sold final expense insurance and voluntary benefits such as vision and dental. 
  • Secondary focus was on Life Insurance; both permanent and term products. 
Associate Claims Adjuster Jan 2005Mar 2007 USAA
  • Licensed Property and Casualty Adjuster for Texas and Oklahoma. 
  • Responsible for investigation of non-injury automobile claims. Assess property damage liability and determine fault.
  • Negotiate property and physical damage settlements. 
Associate Claims Adjuster Sep 2001Dec 2004 Allstate Insurance
  • Responsible for Liability investigation including: recording statements, obtaining police reports, setting up appointments for property damage assessment and explain the claim processes to the involved parties.
  • Communicating liability decision to all involved parties, explaining factors leading to decision, negotiating damages and following all processes for documentation of information pertaining to the claim.  
Education
Bachelor of Arts Degree : Sociology Jan 1997 The University of Texas San Antonio, Texas
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Resume Details

This is a real resume for a Cosmetologist in San Antonio, TEXAS with experience working for such companies as Cgi, Wells Fargo, United Healthcare. This is one of the hundreds of Cosmetologist resumes available on our site for free. Use these resumes as templates to get help creating the best Cosmetologist resume.

Previous Companies:

  • CGI
  • Wells Fargo
  • United Healthcare

Previous Job Positions:

  • Cosmetologist
  • Quality Control Specialist
  • Independent Insurance Agent

Schools:

  • The University of Texas

Level of Education:

  • Bachelor of Arts Degree

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