Luis Ruiz
Cidra
Summary
Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
14
14
years of professional experience
Work History
A&G Claims Representative
Optum Inc.
San Juan, Puerto Rico
12.2021 - 10.2023
- Handle Member and Provider Claims.
- Execute audits for new hires and gave them feedback on their performance.
- Audit appeals to ensure they are accurately processed.
- Assist new hires once on the production floor with any questions they might have.
- Review and verify claim information to ensure accuracy of data and compliance with established policies.
- Collaborate with other departments.
- Process a high volume of claims efficiently while maintaining quality standards.
Incoming Call Center Representative
Conduent
Guaynabo, Puerto Rico
11.2020 - 12.2021
- Handled incoming calls from members, around 30 calls a day or more depending on the day of the week
- Researched Member Medical and Pharmacy Claims
- Activated Meal and Prescription Prepaid cards for Members
- Placed Over the Counter orders for members.
- Placed Transportation Reservations for Members to their Doctor Appointments.
- Worked exclusively with Medicare Members counseling them on their individual plans.
- Performed Demographic & Primary Care Physician Changes for Members
- Ordered medication refills for members and ensure they are shipped to them in a timely basis
- Translated correspondence content shipped to Members sent from the state or Humana
- Ordered replacement Medical ID cards for members when they lose their cards.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Managed customer expectations by clarifying needs, identifying options and recommending products and services.
- Adhered strictly to all applicable laws and regulations pertaining to customer privacy rights.
Spa Coordinator
Sparkling Waters Salon & Spa
Strongsville, Ohio
10.2019 - 03.2020
- Greeted incoming guests that were either walk-ins or had appointments.
- Ensured that every guest interaction was memorable by pairing them with the correct employee in the salon.
- Made phone calls on a daily basis in order to ensure follow up appointments and drive business into the Salon.
- Spearheaded Inventory control procedures in order to minimize shrink.
- Troubleshooted any Customer Service issues that would arise in person or over the phone.
- Followed up on all open purchase orders with suppliers to ensure timely delivery of items.
- Prepared purchase orders according to specified requirements.
- Verified receipt of items by comparing items ordered to items received.
- Investigated discrepancies between invoices received from suppliers and actual delivered goods.
Store Manager
AVEDA
Cleveland, OH
06.2018 - 01.2019
- Hired and Trained new team members on the Aveda way.
- Ensured they were comfortable, through product knowledge: -Role played with team members how to sell our product through acting out different scenarios in order to increase their confidence level when selling the product to our guests
- Processed shipment and ensured team members were practicing good behaviors resulting in Inventory Integrity.
- Captured guest information in order to increase our database through daily coaching of behaviors on the selling floor.
- Participated and hosted several monthly events in order to generate sales for the store with mall traffic trending down.
- Managed inventory tracking and physical inventory counts to minimize loss.
- Prepared monthly reports on sales figures, expenses, profits.
ASSISTANT STORE MANAGER
THE ART OF SHAVING, BEACHWOOD PLACE
CLEVELAND, OH
01.2017 - 01.2018
- Assisted with the day to day operations of the store while maintaining the highest level of customer service provided
- Consultation driven business by catering to every clients’ different skincare needs through deep probing of their shaving concerns
- As a store, we led the region in metrics helping us to have a substantial surplus on the year due to in depth product training team selling
- Client outreach to both retain regular loyal guests, as well as follow up with new guests we just met.
TORY BURCH, GENERAL MANAGER
BROOKFIELD PLACE
New York, NY
01.2011 - 01.2017
- Received award in 2016 for #1 store in the company to comp
- Last year’s numbers
- Manage a projected $2.8 million business keeping the company’s core values intact while working towards meeting financial goals
- Elevate the sales’ team performance with respect to metrics such as UPT, Conversion, AT and AUR through in the mom coaching of positive selling behaviors
- Responsible for the recruiting, hiring, and on-boarding of store team
- Have worked in 5 different store locations, experiencing different markets
- Instrumental in helping with the opening of 2 Full Price stores, and 1 Accessory door
- BLOOMINGDALES
- Onboarded new employees in time reporting and payroll systems.
- Voided checks and issued stop payment orders to correct payroll discrepancies.
- Maintained and updated database for invoicing and accounting reconciliation.
- Anticipated potential payroll issues and questions to take proactive action and prevent development of problems.
- Extracted information from payroll system and generated reports for various departments and vendors.
Determinations Letter Coordinator
Optum
San Juan, PR
10.2023 - 07.2024
- Generate Behavioral Health Denial letters for members with Commercial, Medicare & Medicaid health plans.
- Chosen to participate to work with handling all BCBSM Denial letters, a new account for our offshore market.
- Assist with auditing all BCBSM letters in partnership with another Determination Letter Coordinator.
- Partner with teammates in order to ensure that our letters are written within the correct time constraints in order to stay within compliance.
Education
Cornell University
Ithaca, NY1996
High School Diploma -
East Side High School
06-1994
Skills
- Data Analysis
- Claims Investigation
- Insurance Claims Review
- Documentation Research
- Coverage Determination
- Database Management
- Attention to Detail
- Deadline-Driven
- Customer-Focused
- Customer Service-Oriented
- Experienced with ETS & Facets Platforms
Languages
English
Bilingual or Proficient (C2)
Timeline
Determinations Letter Coordinator
Optum
10.2023 - 07.2024
A&G Claims Representative
Optum Inc.
12.2021 - 10.2023
Incoming Call Center Representative
Conduent
11.2020 - 12.2021
Spa Coordinator
Sparkling Waters Salon & Spa
10.2019 - 03.2020
Store Manager
AVEDA
06.2018 - 01.2019
ASSISTANT STORE MANAGER
THE ART OF SHAVING, BEACHWOOD PLACE
01.2017 - 01.2018
TORY BURCH, GENERAL MANAGER
BROOKFIELD PLACE
01.2011 - 01.2017
Cornell University
High School Diploma -
East Side High School