Alyssa Farias
Santa Clarita
Summary
Results-oriented professional in appeals analysis field. Proven ability to thoroughly review and resolve complex cases with high accuracy, ensuring compliance and customer satisfaction. Known for strong collaboration and adaptability, consistently meeting team goals and adapting to changing requirements. Key strengths include analytical problem-solving and effective communication.
Overview
11
11
years of professional experience
Work History
Grievance & Appeals Analyst I
Elevance Health
Woodland Hills, CA
06.2022 - Current
- Manage high-volume, complex grievance and appeals cases, ensuring timely resolution in compliance with healthcare regulations and internal policies
- Review and analyze medical claims, documentation, and case details to identify discrepancies and ensure accuracy
- Collaborate with cross-functional teams, including providers and internal departments, to resolve issues and improve patient outcomes
- Maintain detailed and compliant documentation, ensuring audit readiness and adherence to regulatory standards
- Identify process inefficiencies and contribute to workflow improvements to enhance operational efficiency
- Communicate effectively with internal stakeholders to provide case updates, clarify requirements, and ensure alignment on next steps
- Prioritize and manage multiple cases simultaneously in a fast-paced environment while meeting strict deadlines and performance metrics
- Analyzed appeals data to identify trends and improve resolution processes.
- Managed over 25 cases a day
Behavioral Therapist
Autism Learning Partners
Santa Clarita, CA
02.2026 - 05.2026
- Provided one-on-one behavioral therapy to children with autism using Applied Behavior Analysis techniques
- Implemented individualized treatment plans created by supervising clinicians and tracked client progress through detailed session notes and data collection
- Supported clients in developing communication, social, and emotional regulation, and daily living skills
- Managed challenging behaviors using de-escalation techniques, positive reinforcement, and behavior intervention strategies
- Collaborated with families, supervisors, and multidisciplinary teams to ensure consistency in client care and treatment goals
- Adapted quickly to changing client needs while maintaining a safe, supportive, and structured environment
- Demonstrated strong patience, empathy, crisis management, and problem-solving skills in high-stress situations
Customer Care Representative I
Anthem
Woodland Hills, CA
08.2021 - 06.2022
- Trusted Advisor and educator on health care related inquiries
- Proactively resolving our members and/or providers questions and concerns using computer based resources to find answers
- Guide members and providers with their healthcare needs by explaining benefits, solving calm concerns, helping find a doctor via telephone calls, online chats or emails
- Partner internally to create a seamless experience for our customers and resolve potential issues
- Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims
- Analyzes problems and provides information/solutions
- Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintain positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in timely manner
- Researches and analyzes data to address operational challenges and customer service
- Provides external and internal customers with requested information
- Under immediate supervision, receives and places follow-up telephone calls/ e-mails to answer customer questions that are routine in nature
- Uses computerized systems for tracking, information gathering and troubleshooting
- Seeks, understands and responds to the needs and expectations of internal and external customers
Supervising Sales Associate
Cotton On
Thousand Oaks, CA
10.2020 - 02.2021
- Maintains appropriate store inventory levels to ensure merchandise is consistently available
- Supervises and motivates staff daily to maintain a powerful team spirit
- Took over responsibility for training sales associates
- Conducted transactions and ensured that the drawer was balanced at the end of each day
- Interviewed candidates for sales associate and merchandiser positions, ensuring all qualifications were met before extending offers
- Store key holder
Sales Associate
JJILL
Manhattan Beach, CA
10.2019 - 08.2020
- Provided excellent customer service by greeting patrons, answering inquiries, providing product information, handling transactions, and suggesting recommendations based on assessment of customers’ needs
- Created visual displays of merchandise and updates monthly
- Maintained cleanliness, organization, and appearance of store
Guest Service Agent
European Wax Center
Torrance, CA
06.2018 - 09.2019
- Answered inquiries, remaining attentive to customer needs, and ensuring appointments were scheduled, promoted and sold appropriate client packages
- Handled transactions and coordinated with wax specialists and fellow agents through consistent communication to ensure smooth operations
Sales Associate
H&M
Belmont, CA
10.2017 - 05.2018
- Provided excellent customer service by greeting patrons, answering inquiries, providing product information, handling transactions, and suggesting recommendations based on assessment of customers’ needs
- Created visual displays of merchandise and update monthly
- Independently managed a team of 2-3 employees to successfully close the store
- Helped resolve and compensate for problems, upgrading quality and ensuring complete customer satisfaction
- Assisted in opening and closing of the store, including cash handling and preparing deposits.
- Engaged customers in a conversation to understand and meet their needs by providing them with appropriate products and service, resulting in meeting the stores daily sales target.
- Maintained cleanliness, organization, and appearance of store
General Office Support
Coast II Coast Installation
Los Angeles, CA
01.2015 - 07.2017
- Processed payroll including commission for all employees and handle all accounts payable as well as accounts receivable
- Ensured all office equipment was in working order and the office is well-supplied by assisting in day to day deliverables as needed
- Held the position as liaison between the firm and clients on various projects
- Conducted basic administrative assistant duties, such as set up travel itineraries as well as booking travel, including flights, hotels and car service
Education
Master of Business Administration (MBA) - Project Management Emphasis
California State University
Chico05-2025
Bachelor of Arts - Criminal Justice and Minor in Psychology
Marymount California University
Palos Verdes, CA05-2021
Bachelor of Arts - Psychology
Notre Dame De Namur University
Belmont, CA05-2018
Skills
- Healthcare operations management
- Data analysis and reporting
- Workflow efficiency
- Cross-functional collaboration
- Case evaluation
- Verbal communication
- Legal research
- Policy interpretation
- Teamwork
- Problem-solving
- Time management
- Attention to detail
- Claims investigation
Timeline
Behavioral Therapist
Autism Learning Partners
02.2026 - 05.2026
Grievance & Appeals Analyst I
Elevance Health
06.2022 - Current
Customer Care Representative I
Anthem
08.2021 - 06.2022
Supervising Sales Associate
Cotton On
10.2020 - 02.2021
Sales Associate
JJILL
10.2019 - 08.2020
Guest Service Agent
European Wax Center
06.2018 - 09.2019
Sales Associate
H&M
10.2017 - 05.2018
General Office Support
Coast II Coast Installation
01.2015 - 07.2017
Bachelor of Arts - Criminal Justice and Minor in Psychology
Marymount California University
Master of Business Administration (MBA) - Project Management Emphasis
California State University
Bachelor of Arts - Psychology
Notre Dame De Namur University