Cristina Legrand La Luz
Bayamon
Summary
Dynamic and results-driven Claims Representative at Optum with expertise in medical terminology and a proven track record in complaint resolution. Bilingual and adept at analyzing claim trends to enhance processing efficiency. Recognized for maintaining confidentiality and delivering exceptional customer service in fast-paced environments. Contracted by agency Casiano Entertainment as Voice Actress.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Claims Representative
Optum
San Juan, Puerto Rico
07.2024 - Current
- Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
- Identified potential fraud indicators during the review process and reported suspicious activity accordingly.
- Conducted research into medical terminology related to healthcare claims processing activities.
- Resolved complex discrepancies in policyholder files to facilitate accurate claim processing.
- Documented changes in claim statuses using specialized software systems.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Investigated facts, confirmed coverage and liability, negotiated settlements, and determined payments for claims.
- Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
- Analyzed trends in claim denials or delays to identify areas for improvement within the organization.
- Reviewed documentation and accounts to gain full picture.
- Maintained detailed records of claims, decisions, and financial transactions in compliance with regulatory requirements.
- Utilized claims management software to track claims progress and maintain organized documentation.
- Evaluated and processed insurance claims according to company policies and industry standards.
- Used programs such as COMET, UNET, and OMEGA for claim processing.
Customer Service Representative
Delta dental
Guaynabo
09.2020 - Current
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Assisted customers with product selection, ordering, billing, returns, exchanges and technical support.
- Assisted customers with information about dental insurance such as benefits, providers and claims
- Submit grievances for dissatisfied customers
- Assistance with sending information regarding dental insurance
- Working with other members of customer service team
- Meet reasonable customer satisfaction goals
Customer Service Representative
Conduent
Guaynabo
07.2019 - 06.2020
- Answered customer inquiries and provided accurate information regarding products and services.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Executed routine inbound and outbound call center activities
- Inquired information for Fraud dispute creation and resolution
- Provides phone support to address the needs of members or providers, taking care to thoroughly understand the type of assistance required
Food Runner
Ujeong Korean BBQ
San Juan
08.2018 - 10.2018
- Assisted servers in setting up tables for guests.
- Organized food orders and ensured accuracy of items served to customers.
- Greeted and welcomed customers as they arrived at the restaurant.
- Delivered food to guests in a timely manner while following safety protocols.
- Replenished water glasses, bread baskets, condiments and other necessities during meal service.
- Provided assistance with clearing plates from tables after meals were completed.
Clerical Assistant
Gizelle Auto Imports
Guaynabo
06.2017 - 07.2018
- Greeted visitors and customers in a friendly, professional manner.
- Assisted with filing documents and maintaining records.
- Answered phone calls and directed them to the appropriate personnel.
Education
Certificate - Voice Acting
Casiano Entertainment
San Juan Puerto Rico01-2024
High School Diploma -
High School Cacique Agueybana
Bayamon06.2016
Skills
- Bilingual
- Excellent creative writing skills
- Experienced customer service representative
- Fast learner and adaptable to fast paced environment
- Efficient communication skills
- Information Security
- Call Management
- Complaint Resolution
- Inbound and Outbound Calling
- Account Updating
- Critical Thinking
- Medical Terminology Knowledge
- Active Listening
- Typing Proficiency
- Filing
- Claims processing
- Medical terminology
- Customer service
Languages
Spanish
First Language
English
Proficient (C2)
C2
Korean
Beginner
A1
Chinese (Mandarin)
Beginner
A1
Certification
- Certified Voice Actress, contracted by the agency Casiano Entertainment
Affiliations
- Twitch Streamer
Timeline
Claims Representative
Optum
07.2024 - Current
Customer Service Representative
Delta dental
09.2020 - Current
Customer Service Representative
Conduent
07.2019 - 06.2020
Food Runner
Ujeong Korean BBQ
08.2018 - 10.2018
Clerical Assistant
Gizelle Auto Imports
06.2017 - 07.2018
High School Diploma -
High School Cacique Agueybana
Certificate - Voice Acting
Casiano Entertainment
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