Melissa Rivera Acevedo
San Sebastian
Summary
Analytical and strategic nurse with excellent problem-solving and time management skills. Organized, efficient and always willing to go the extra mile to exceed expectations. Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Claims Analyst Nurse/ Horizon Blue Cross Blue Shield
Infosys BPM
01.2024 - Current
- Maintained strict confidentiality with all personal data as per company guidelines. 2
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims. 3
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions. 4
- Demonstrated a commitment to continuous improvement by actively seeking out opportunities for process optimization within the medical claim’s analyst role. 5
- Verified client information by analyzing existing evidence on file.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Interacted with clients and employees, which helped cultivate positive working relationships.
Utilization Management Nurse/CVS Specialty Pharmacy
Infosys BPM
01.2022 - 01.2024
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services. 2
- Performed prior authorization review of services requiring notification. 3
- Submitted cases for criteria failures and helped facilitate resolutions and approvals. 4
- Evaluated patient histories, complaints, and current symptoms. 5
- Reduced patient wait time for approval by diligently reviewing medical records and obtaining necessary documentation.
- Accomplished multiple tasks within established timeframes.
- In Charge of the night shift assisting my colleagues with any doubts.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
Education
Bachelor of Science in Nursing -
Interamerican University
Aguadilla, PR01.2014
Skills
- Work with minimum supervision
- Ability to learn fast
- Excellent interpersonal relationships and good communication
- Responsible, organized and punctual
- Basic knowledge in computer system programs
- Bilingual
- Claims
- Claims analysis
- Critical thinking
- Healthcare Common Procedures Coding System (HCPCS)
- Policy Interpretation
- Interpersonal and written communication
- Clinical documentation
- Leadership skills
Accomplishments
- On May 12, 2017 I was recognized by the nursing administration of the Good Samaritan Hospital in Aguadilla Puerto Rico, for my performance, responsibility and willingness to offer my services with dedication to my patients.
- On May 12, 2017 I was recognized by the nursing administration of the Good Samaritan Hospital in Aguadilla Puerto Rico, for my dynamism, commitment and excellent service in the delivery room department.
- On October 2023 and February 2024 I was recognized by Infosys BPM as the employee of the month for my hard work and commitment.
Certification
- CPR & AED certification
- Nursing License – Puerto Rico Board of Nursing
- Nursing License – Florida Board of Nursing
- Professional Nursing Collegiate of Puerto Rico
References
Available upon request.
Languages
Spanish
Native language
English
Intermediate
B1
Timeline
Claims Analyst Nurse/ Horizon Blue Cross Blue Shield
Infosys BPM
01.2024 - Current
Utilization Management Nurse/CVS Specialty Pharmacy
Infosys BPM
01.2022 - 01.2024
Bachelor of Science in Nursing -
Interamerican University