Lisset Espinosa
Omaha
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Hardworking and passionate with strong organizational skills eager to secure entry-level medical records specialist position. Ready to help team achieve company goals.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Appeals Specialist
Blue Cross Blue Shield Of Nebraska
12.2017 - 01.2025
- Handled incoming and outgoing calls for members and providers regarding appeals.
- Conducted thorough documentation and record keeping for all appeals cases.
- Set up appeals from members, providers, and the Department of Insurance.
- Processed claims and pre-authorizations, ensuring compliance with company policies.
- Developed training materials and trained new team members on appeals processes.
- Handled emails from various departments from within the company.
- Utilized various systems for efficient appeal processing and tracking.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
Customer Service Representative
BlueCross BlueShield of NE
09.2011 - 12.2017
- handled incoming phone calls from members and providers.
- Handled benefit/claims questions for medical, pharmacy and dental.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
Education
High School Diploma -
Buena High School
Ventura, CASkills
- HIPAA compliance
- Adaptability and flexibility
- Effective communication
- Professionalism and ethics
- Continuous learning mindset
- Documentation expertise
- Insurance policies
- Appeals process proficiency
- Teamwork
- Customer service
- Time management
- Attention to detail
- Multitasking
Certification
None Specified
Languages
Spanish
Native or Bilingual
Timeline
Appeals Specialist
Blue Cross Blue Shield Of Nebraska
12.2017 - 01.2025
Customer Service Representative
BlueCross BlueShield of NE
09.2011 - 12.2017
High School Diploma -
Buena High School