Dana Melendez
Carolina
Summary
With a proven track record at Optum, United Health Group, I excel in enhancing customer satisfaction and streamlining claim processes. My expertise in data entry and strong interpersonal skills have significantly improved operational efficiency. Achievements include reducing claim errors and fostering professional growth among junior staff, demonstrating both hard and soft skills essential for leadership roles.
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Experienced with customer service and administrative tasks. Utilizes communication and problem-solving skills to address inquiries effectively. Track record of maintaining positive client relationships and ensuring customer satisfaction.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Contact Representative
Internal Revenue Service, IRS
01.2024 - Current
- Adapted communication style based on individual preferences or cultural backgrounds of clients, ensuring clear understanding from both parties.
- Managed a high volume of inbound calls daily, maintaining composure under pressure while providing top-notch service to clients.
- Provided exceptional service by proactively addressing customers'' needs and concerns.
- Improved customer satisfaction by resolving issues efficiently and professionally.
- Conducted thorough research on complex inquiries, delivering informed solutions to customers'' unique challenges.
- Collaborated closely with other departments to ensure seamless support for customers throughout their journey with the company.
- Maintained detailed records of customer interactions, ensuring accurate documentation for future reference or follow-up actions.
- Participated in regular professional development opportunities to enhance skills and stay current on industry trends.
- Increased customer retention by expertly handling escalated issues in a timely manner.
- Built lasting relationships with clients through effective communication and attentive service.
- Proactively identified potential areas of improvement within the contact center''s operations, offering suggestions and helping to implement changes that led to enhanced customer experiences.
- Demonstrated empathy when addressing sensitive situations, creating trust between the company and clientele.
- Supported sales efforts through targeted outreach activities, resulting in new client acquisitions.
- Guided customers through troubleshooting processes with patience and understanding, ultimately resolving technical issues quickly and efficiently.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Cross-trained and provided backup support for organizational leadership.
- Increased efficiency and performance by monitoring team member productivity and providing feedback.
Operations Manager
Alliance Network, Inc
01.2023 - 12.2023
- Supervised operations staff and kept employees compliant with company policies and procedures.
- Empowered employees to take ownership of their responsibilities, leading to increased accountability and improved performance outcomes.
- Conducted regular performance reviews, identifying areas for improvement and developing action plans to address them.
- Managed inventory and supply chain operations to achieve timely and accurate delivery of goods and services.
- Led hiring, onboarding and training of new hires to fulfill business requirements.
- Developed and maintained relationships with external vendors and suppliers.
- Enhanced customer satisfaction by establishing clear communication channels and addressing concerns promptly.
- Established positive and effective communication among unit staff and organization leadership, reducing miscommunications, and missed deadlines.
- Analyzed and reported on key performance metrics to senior management.
- Oversaw facility maintenance, ensuring optimal functionality of equipment and infrastructure at all times.
Claims Operation Manager
INMEDIATA
06.2021 - 12.2022
- Conducted thorough investigations into suspicious or potentially fraudulent claims, reducing financial risk to the company.
- Negotiated favorable settlements for disputed claims, protecting company interests while maintaining client relationships.
- Reduced claim turnaround time with the introduction of automation in key operational areas.
- Maintained current knowledge of industry trends, regulatory changes, and emerging best practices in claims management to inform strategic decisionmaking.
- Improved overall efficiency of the claims department by regularly reviewing workflows and identifying opportunities for optimization.
- Evaluated performance metrics for individual team members, providing constructive feedback during regular reviews to support ongoing development goals.
- Developed data-driven strategies for continuous improvement in claims management processes.
- Managed vendor relationships to ensure effective coordination of services related to claim handling, such as medical examinations or vehicle repairs.
- Spearheaded cross-functional team collaboration to address complex claims issues and implement best practices.
- Enhanced customer satisfaction by improving communication channels and providing timely updates on claim status.
- Proactively identified potential bottlenecks or inefficiencies in existing processes, implementing targeted improvements to enhance overall department performance.
Medical Claims Supervisor
Optum, UnitedHealth Group
10.2018 - 06.2021
- Participated in strategic planning sessions aimed at enhancing service offerings for clients in the managed care sector.
- Enhanced customer satisfaction with timely resolution of complex medical claims.
- Championed continuous improvement initiatives within the department, leading efforts aimed at operational excellence.
- Improved claim processing efficiency by streamlining workflows and implementing new software tools.
- Mentored junior staff, fostering professional growth and improving overall team performance.
- Oversaw regular audits of processed claims to identify patterns of error or potential fraud indicators.
- Negotiated favorable settlement terms with healthcare providers, reducing financial liabilities for the organization.
- Optimized resource allocation by monitoring staff productivity levels and adjusting assignments accordingly.
- Streamlined communication between departments, ensuring timely updates on claim status and relevant issues.
- Reviewed claim documentation for compliance with regulatory requirements, minimizing risk of audits or penalties.
- Maintained up-to-date knowledge of industry trends and regulations, ensuring adherence to all relevant guidelines.
- Coordinated cross-functional teams to address key areas of concern in the claims process.
- Assisted in the development of company-wide best practices for medical claims management, increasing overall efficiency.
- Managed a high volume of claims daily, prioritizing workload according to urgency and complexity.
- Reduced claim errors by providing thorough training and guidance to claims team members.
- Collaborated with healthcare providers to ensure accurate billing and reduce disputes.
- Implemented strict quality control measures for medical claim submissions, resulting in fewer denials and appeals.
Education
Bachelor of Arts - Business Administration
Ana G Mendez
Guaynabo, Puerto RicoSkills
- Goal oriented
- Empathy and patience
- Data entry proficiency
- Assertiveness
- Social perceptiveness
- Cross-cultural sensitivity
- Strong interpersonal skills
- Customer service
- Problem-solving skills
- Call center customer service
- Resolving issues
- Customer communications
- Verbal and written communication
- Inbound phone calls
- Customer support
Certification
- Six Sigma Certification (Green Belt, Black Belt, Master Black Belt) - American Society for Quality.
Languages
Spanish
Native language
English
Proficient
C2
Timeline
Contact Representative
Internal Revenue Service, IRS
01.2024 - Current
Operations Manager
Alliance Network, Inc
01.2023 - 12.2023
Claims Operation Manager
INMEDIATA
06.2021 - 12.2022
Medical Claims Supervisor
Optum, UnitedHealth Group
10.2018 - 06.2021
Bachelor of Arts - Business Administration
Ana G Mendez
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