Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

AIDELMA JUAREZ

Baytown,Tx

Summary

Highly professional with a comprehensive background in health administration and insurance paperwork. Expertise in claims processing, data entry, insurance eligibility, and enrollment applications. Experience in customer service by handling high volume inbound and outbound calls by providing efficient service to patients regarding their health insurance and the status of their enrollment process. Exceptional abilities to maintain member confidentiality through HIPPA compliance and accurate bookkeeping. Able to function well independently or as a member of a health administrative team. Experienced with Word, Outlook, Excel, PowerPoint and Adobe Acrobat

Overview

14
14
years of professional experience
1
1
Certification

Work History

Enrollment Processor

HealthFirst
09.2023 - 11.2023
  • Responded promptly to emails or phone calls from applicants seeking updates on their application status
  • Ensured all necessary forms were completed accurately before submitting them for processing
  • Order insurance member ID cards for members who were renewing and members who are new to HealthFirst
  • Review authorized representative letters and input authorization into the system.

Data Entry Insurance Specialist

Hermann Law
01.2023 - 03.2023
  • Read declination letters from insurance companies and enter critical information such as letters representing victims of sexual abuse onto an Excel doc (some of the column examples)

Index # - Name of claimant - Carrier - Type of Insurance - Claim Status - Reason for declination Note: Was hired by a third-party Jacobson Group, was only a 3-month contract

Enrollment Processor

United Healthcare
03.2022 - 11.2022
  • Processed and reviewed member applications for accuracy and completeness.
  • Update records
  • Renew memberships
  • Analyze and evaluate enrollment documents, for the continuation of memberships
  • . Spoke with insurance agents and applicants for information that was missing to complete the application or any missing documents

Financial Counselor

Mckesson
03.2022 - 11.2022
  • Improved client financial stability by assessing their financial situations and developing tailored plans.
  • Assisted clients in reducing debt through customized repayment strategies and budget adjustments.
  • Enhanced financial literacy for individuals and families by conducting educational workshops on budgeting, credit management, and savings.
  • EDI transactions between healthcare providers and insurance companies.
  • Collaborated with other professionals to provide comprehensive financial counseling services, addressing all aspects of a client's financial life.


CDC Vaccine Representative

Maximus
05.2020 - 07.2021
  • Provided outstanding customer service and support to clients, resolving COVID19 questions efficiently and effectively.
  • Navigated multiple applications and utilized search tools to find information for customer inquiries to find a vaccine.
  • Helped Schedule appointments for customers who wanted to get vaccinated.

Member Service Representative

Humana
08.2018 - 02.2020
  • Provided excellent customer service by assisting, responding to, and resolving customer inquiries on policy benefits.
  • Utilized problem-solving techniques to resolve customer complaints and issues quickly and efficiently.
  • Maintained accurate records of patient interactions, including notes on billing concerns, insurance policies, medical procedures, and other related topics

Cashier

Kfc
05.2010 - 01.2014
  • Operated cash register and accurately processed payments, returns, and exchanges
  • Performed opening and closing procedures, such as counting cash register, restocking, and cleaning
  • Accurately process customer payments using cash, credit cards, and checks
  • Provided efficient and courteous service to customers
  • Trained new employees

Education

Associate in Science (A.S.) - Healthcare Administration

Ultimate Medical Academy
06.2020

Skills

  • Organizational Skills
  • Data Entry Accuracy
  • Application Processing
  • Enrollment Verification
  • Computer Proficiency
  • Medical EDI transactions
  • Customer Service
  • Policy Knowledge
  • Insurance Claim Forms Review
  • Insurance Coverage Verification
  • Application Review
  • Decision-Making
  • Eligibility Determination
  • HIPPA

Certification

Medical Administrative Assistant

Timeline

Enrollment Processor

HealthFirst
09.2023 - 11.2023

Data Entry Insurance Specialist

Hermann Law
01.2023 - 03.2023

Enrollment Processor

United Healthcare
03.2022 - 11.2022

Financial Counselor

Mckesson
03.2022 - 11.2022

CDC Vaccine Representative

Maximus
05.2020 - 07.2021

Member Service Representative

Humana
08.2018 - 02.2020

Cashier

Kfc
05.2010 - 01.2014

Associate in Science (A.S.) - Healthcare Administration

Ultimate Medical Academy
AIDELMA JUAREZ