Summary
Overview
Work History
Education
Skills
Languages
Timeline
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Afimayi Galarraga

Palmdale,CA

Summary

Proven track record in claims processing and case management, with a knack for accuracy and precision honed at Pharmacy Care Center. Excelled in roles requiring analytical problem-solving and effective customer service, achieving high compliance and efficiency. Skilled in Microsoft Office and data entry, adept at streamlining operations and enhancing client satisfaction.

Overview

24
24
years of professional experience

Work History

Claims Processor

Pharmacy Care Center
04.2019 - 01.2024
  • Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
  • Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
  • Identified fraudulent claims through thorough investigation and documentation of findings.
  • Utilized specialized software to process incoming claims, enter data and generate reports.

Assistant Office Manager

Dr. Otto Bedoya Family Practice
08.2012 - 04.2019
  • Managed daily operations, ensuring timely completion of tasks and maintaining a well-organized work environment.
  • Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
  • Created and updated records and files to maintain document compliance.
  • Maintained inventory of office supplies, proactively restocking materials when needed to minimize downtime due to shortages.
  • Bilingual claim processing handling
  • Created and updated physical records and digital files to maintain current, accurate, and compliant documentation.

Consultant & Assistant To Affluent Entity (NDA)

NDA
05.2002 - 07.2012

Due to a Non-Disclosure Agreement (NDA) with employer, I am unable to reveal nor give any information as to the nature of my work with this entity.

Case Manager

Miami Behavioral Health Center
10.1999 - 04.2002
  • Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
  • Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
  • Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
  • Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
  • Served as a liaison between psychiatrist and clients
  • Interviewed clients to determine their necessities and properly assisted them in areas of need
  • Handled client intake assessment as well as their exit report


Education

Associate of Arts -

Pima Community College
Tucson, AZ
06.2012

Skills

  • Claims review
  • Accuracy and Precision
  • Transactions reconciliation
  • Claims
  • Data entry proficiency
  • Data Entry
  • Claims Processing
  • Microsoft Office
  • Customer Service
  • Account Management
  • Excel Outlook
  • CPT Codes

Languages

Spanish
Native or Bilingual

Timeline

Claims Processor

Pharmacy Care Center
04.2019 - 01.2024

Assistant Office Manager

Dr. Otto Bedoya Family Practice
08.2012 - 04.2019

Consultant & Assistant To Affluent Entity (NDA)

NDA
05.2002 - 07.2012

Case Manager

Miami Behavioral Health Center
10.1999 - 04.2002

Associate of Arts -

Pima Community College
Afimayi Galarraga