Experience

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  GM Financial

  • Executive Operations Support Specialist

    • Mar 2023 - Present

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  USAA

  • United States
  • Financial Services
  • 700 & Above Employee

  • Auto Injury Claims Adjuster

    • Jun 2020 - Mar 2023

    Investigates, evaluates, negotiates and adjusts moderately complex auto claims presented by or against our insured to confirm coverage, determine legal liability and equitably settle/defend in compliance with all state regulatory requirements. Works under limited supervision to perform work assignments and problem resolution. Recognizes life events, understands member’s needs and provides advice in order to deliver appropriate solutions to members.

  • Life & Health Specialist

    • Mar 2019 - Jun 2020

  • Claims Adjuster

    • Apr 2015 - Feb 2019

    Inside Auto Adjuster III for USAA, investigating, evaluating, negotiating and adjusting moderately complex auto claims presented by or against our insureds to confirm coverage, determine legal liability and equitably settle/defend in compliance with all state regulatory requirements. Working under direct supervision, perform routine work assignments and problem resolution. Recognizing life events, understand member's needs and provide advice in order to deliver appropriate solutions to the member. Current insurance adjuster's license. Working in a call center environment.

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  Texas Department of Assistive and Rehabilitative Services

  • San Antonio, Texas Area

  • Medical Claim Examiner/Surgery Coordinator

    • Jul 2005 - Mar 2015
    • San Antonio, Texas Area

    Experience in an office environment coordinating medical services including surgery, testing, consultations and appropriate payment coordination and processing of payments for medical claims, utilizing standardized medical records procedures, methods and requirements covering the establishments, coding, maintenance and disposition of patient records sufficient to code diagnostic and operative/procedural information. Responsible for written & verbal reporting of statistics and development of complex financial reports. Perform reporting of monthly data and cumulative cost projections. Identified cost savings to the state for Fiscal Year 2014: $203,529.39 with healthcare and insurance experience. Administer administrative financial budgets and project budgeting costs and financial internal controls and call center experience. Locate and extract pertinent information from medical files. Maintaining records and budget preparation and related accounting functions of accounts payable. Initiates, maintains and codes medical records in accordance with prescribed directives. Provide technical assistance to other departments and offices and making presentations and training and consultation. Responding to general and complex questions and complaints regarding department and work. Receive, document and resolve customer service inquiries via telephone by using best practices. Maintain professionalism and effective business relationships with providers/facilities. Utilization Review and approval procedures for Inpatient hospitalization and ancillary medical services.

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  Florida Department of Health

  • Orlando, Florida

  • Medical Disability Claims Examiner

    • Jan 2004 - Jun 2005
    • Orlando, Florida

    Process assigned claims for Social Security Disability and/or Supplemental Security Insurance benefits to determine disability and benefits to be awarded in accordance with statues, rules, case law and strict time frames. Confer with physicians and psychologists in person to determine disability regulations. Analyze medical reports on claims regarding disease processes and functional limitations related to vocational factors to appropiately evaluate medical claims. Handle attorney represented applications for disability eligibility. Responsible for maintaining a case load for approximately 150 cases and a weekly intake of 15 new cases per week.

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  Florida Dept of Children & Families

  • Sanford, Florida

  • Case Worker

    • Mar 2003 - Dec 2003
    • Sanford, Florida

    Determine eligibility for TANF, Food Stamps and Medicaid applications and reviews. Interview applicants, verify and document case data, make decisions concerning eligibility, completion of forms, home visits and other duties. Determine eligilbity within regulations and requirements of policies and procedures.

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  Texas Department of Human Services

  • San Antonio, Texas

  • Program Administrator/Supervisor/Case Worker/Technician

    • Nov 1981 - Mar 2003
    • San Antonio, Texas

    Plan, implement, coordinate, monitor and evaluate social service programs. Consult with senior management to define needs or probelms, conduct studies or surgerys to obtain and analyze data and recommend solutions to solve problems using policies and procedures. Supervise19 employees including case workers, clerical and contracted employees, conduct meetings and trainings. Provide training to new employees. Interview, select, manage and train staff.