Background

For many years now, I have not lost the desire to help others needing help.

Job experience

• May 2020 - present
  Claims Adjudicator
  Oregon State Employment Department
  

  Salem, OR, USA

  Claims Adjudicator (Reg/Ui Claims)Wilsonville, OR
  Oregon Employment Department
  Dates: 07/15/20 to current
  Duties: Analyze claims to determine monetary eligibility to receive Unemployment Insurance benefits. Adjudicators investigate potentially disqualifying issues using fact finding interviews with the parties to the claim. Reviewing all Federal laws, State Statutes, Administrative Rules, and policy manuals relative to the unemployment insurance program.Gathering, evaluating, interpreting, and presenting facts in a relationship to applications of the laws, rules, and policies Recognize and identify claimant eligibility issues, (past, present, and future); uses human relationship skills to gather, evaluate and document pertinent facts from claimants, employers, and others. Analyze claims to determine eligibility for Unemployment Insurance benefits; apply relevant statutes, rules and regulations and determine the need for further investigation and documentation. Investigate potential disqualifying issues and use problem solving methods to determine eligibility for unemployment insurance benefits. Interpret and apply law and policy to each individual situation; prepare a timely written decision to deny or allow benefits which clearly communicate the facts, conclusions and reasoning used to support the decision. Analyze information and documentation gathered and issue decisions. Interview interested parties by telephone and correspondence, to obtain pertinent information and documentation relative to the investigation.
  Pandemic Unemployment Claims Specialist (Business & Employment Specialist 1) Wilsonville, OR
  Dates: 05/2020 to 07/15/2020
  Duties: The primary purpose of this position is to: have regular telephone, Internet, E-mail, and mail contact with individuals filing for and/or claiming Unemployment Insurance benefits. UI Claims Specialist who detect, identify, and set-up potentially disqualifying issues during the initial and the ongoing interactions with the individuals. It is a technical position requiring extensive knowledge of complex Federal laws, State statutes, Administrative Rules, and policy manuals relative to the unemployment insurance program. The position requires skills in identifying issues; gathering, evaluating, interpreting and presenting facts in relationship to application of the laws, rules and policies governing the program. A file is then created and forwarded for review and follow-up to our adjudication department. A UI Claims Specialist is in a production environment and must balance quality and quantity performance expectations and maintains an organized work area. Processes and procedures are adjusted on a regular basis to assure the Integrity of the Program.
  

• May 2019 - May 2020
  Cashier
  Winco Foods
  

  Portland, OR, USA

  Dates: 05/2019 to 5/2020
  Duties: Seeks opportunities to welcome, engage, serve and thank customers. Maintains an atmosphere of friendly, enthusiastic customer service with an emphasis on taking care of the customer, maintains an atmosphere of enthusiastic customer awareness with an emphasis on fast, friendly customer service, operates check stand equipment such as a cash register, scanner and scale to process customer orders using two aisles to check customers,engages in suggestive selling and other sales techniques, processes monetary transactions (i.e., giving and receiving change, etc.) including cash, checks, gift certificates, travelers checks, food stamps, processing coupons, and refunds, maintains knowledge of current product location, monitors UPC codes and ensures proper pricing, maintains clean, neat and properly stocked check stand and ensures safe and secure work area, tickets, prices and rotates merchandise, may be assigned to a multi station self-check-out lane as needed, may be assigned to the customer service counter as needed, performs other duties as assigned or needed.
  

• October 2018 - February 2019
  Medical customer service specialist (work from home)
  Broad-Path Healthcare Solutions
  

  Tucson, AZ, USA

  Dates: 10/2018 to 02/2019
  Duties: Interpret policies and procedures while communicating effectively, apply mathematical concepts and calculations while taking payments, perform research and respond to questions related to patient eligibility, benefits, status of referrals, claims and appeals with multiple usage of applications, educate provider on levels of appeals per company guidelines without seeking assistance from upper management, review cpt and dx codes for accuracy while determining patient benefit outcomes in a high level, fast paced call-center environment and one call resolution manner with courteous and professional manner.
  

• March 2016 - April 2017
  Medical Provider Maintenance Specialist
  Cognizant Technology Solutions
  

  Phoenix, AZ, USA

  Dates: 03/2016 to 04/2017
  Duties: Provider Maintenance Specialist Duties: Verify and maintain new provider or group enrolled numbers and mailing completed agreements to the proper payer/vendor, load new providers' into the database and update any changes with provider and or group demographics, per the guidelines of Health Net, federal/state agencies or Google websites to discern any discrepancies which would create an inconsistency with claim timely payments, enter all credentialing documentation to create participating provider and build records for claims processing while determination of providers enrollment eligible by verification of tax id and NPI numbers and current locations as assigned
  Claims Data Entry Duties: Extract and analyze insurance claims and related business data for operational productive data entries, engage with TPA (Third Party Administrators) to set processes for standard data extracts, management reporting and analytics, collaborate with insurance claims governance and technical departments necessary to achieve data reporting quality objectives to include discrepancies in information and claim format submissions
  

Education

• Modesto High School
  Diploma
  

  1984 - 1985

  Continuation School to obtain my high school diploma
• American InterContiental University
  n/a
  

  2011 - 0

  Studied business admin with a focus on healthcare