Summary
Overview
Work History
Education
Skills
Timeline
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Alyssa Mellizo

Santee

Summary

Adept Claims Adjuster with a proven track record at GEICO, specializing in policy investigations and demonstrating exceptional problem-solving abilities. Expert in insurance regulations and policy coverage, I excel in conflict resolution and claims processing. My meticulous attention to detail and ability to resolve complex issues have significantly enhanced operational efficiency.

Overview

11
11
years of professional experience

Work History

Claims Adjuster

GEICO
07.2021 - Current
  • Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
  • Prepared summaries of damage, payments, and policy coverage.
  • Answered customer questions regarding deductibles.
  • Examined claims forms and other records to determine insurance coverage.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
  • Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
  • Maintained claims data in ATLAS systems.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.

Senior Certified Pharmacy Technician

OptumRx
08.2014 - 07.2021
  • Collected co-payments or full payments from customers.
  • Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
  • Reviewed and verified customer information and insurance provider information.
  • Stocked, labeled, and inventoried medication to keep accurate records.
  • Communicated with prescribers to verify medication dosages, refill authorizations, and patient information.
  • Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
  • Resolved non-routine issues like third-party billing, computer system, and customer service issues.
  • Answered incoming phone calls and addressed questions from customers and healthcare providers.

Education

Associate of Science - Pharmacy Science

Grossmont Health Occupations
San Diego, CA
12-2011

Skills

  • Automobile claims specialist
  • Policy investigations
  • Claims investigations
  • Attention to detail
  • Policy interpretation
  • Problem-solving
  • Insurance regulations
  • Insurance policy coverage expertise
  • Conflict resolution
  • Claims file documentation
  • Claims processing

Timeline

Claims Adjuster

GEICO
07.2021 - Current

Senior Certified Pharmacy Technician

OptumRx
08.2014 - 07.2021

Associate of Science - Pharmacy Science

Grossmont Health Occupations

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Alyssa Mellizo