5/2004 - Present  Member Service Representative    USAA Tampa/Florida 
 
  Property and Casualty Licensed Inside Agent. Handling customers inquiries and
needs in regards to current or future, Auto, Homeowners, Valuable Personal
Property and Fire Insurance Policies. Handling billing inquiries.  
 
10/2003 - 4/2004  Full Function claims processor/Customer Serivce Rep/    Zenith
Administrators  
Phoenix/Az 
 
  Self-funded Medical Insurance Claims processor(Hcfa and UB92 paper claims,
plus EDI & imaged claims), handling group phone calls, adjustment when required.
Handling all Flexible Spending Accounts (claims processing and disbursement of
contributions), processing Short Term disability claims for all groups.  
 
10/2002 - 8/2003  Appeal Claims Review Analysts    Star Administrator Service 
Phoenix AZ/N/A 
 
  Replying to first and second level appeals from insureds, providers and
attorneys concerning benefits applied to their claims. Creating letters while
quoting the corresponding provisions. Developing our department inventory logs. 

 
3/2001 - 6/2002  Benefit Analyst II    AGIA Insurance Services 
Phoenix/Arizona 
 
  -Processing American Legion-Nationwide, hospital indemnity claims and cancer
claims.
- Handling telephone calls from the members 
- Adjustments and overpayment/recoupments
- Pre-existing investigations and appeals.  
 
7/1999 - 3/2001  Research and Recovery Rep    United Healthcare of Arizona 
Phoenix/Arizona 
 
  -Handling HMO provider reports that reflected overpayments in benefits.
- Handling customer service adjustments and appeals 
-Handling recoupments/refunds.  
 
1/1996 - 5/1999  Customer service representative    Pacific Life and Annuity
(AKA PM GROUPS) 
Phoenix/Arizona 
 
  - Answer calls from insurers, agents and providers concerning benefits and
provisions involving indemnity, HMO, PPO, EPO, POS and ASO plans, as well as
state and federal legislation that apply.
- Starting the process when adjustment was required for any issues concerning
the plan or claims.  
 
8/1994 - 12/1995  Full service claims processor.    The Principal Financial
Group 
Phoenix/Arizona 
 
  - Process medical claims 
- Answer calls from insurers, agents and providers  
 
11/1990 - 7/1994  Customer Service Rep and adjuster    John Alden Life Insurance
Company 
Phoenix/Arizona 
 
  *Started with this company as a medical claims processor.
*Once advanced to the customer service dept:
my work consisted of:
- Answering calls from insurers, agents and providers regarding various claim
and plan issues 
- Claims and appeals adjuster for the customer service unit.  
 
Education:  
 
1/1994  Rio Salado Community College  Some College Coursework Completed  
 Phoenix - Arizona - US  
 
6/1987  SW Medical Academy  Vocational  
 Phoenix - Arizona - US  
 
 Soa Martin Community College  Vocational  
 Mexico City - Mexico - Mexico  
 
 South Dade Community College  Some College Coursework Completed  
 Miami - Florida - US  
 
 
 
 
Bilingual-Spanish  Expert  Currently used / 52 years  
Experience with the following computer / Intermediate  Currently used / 30 years
 
 
  
Languages  Proficiency Level  
Spanish  Fluent - Wide Knowledge