Ana Hemenegildo
Fort Lauderdale
Summary
Detail-oriented Medical Claims Examiner with a strong background in health insurance and customer service. Proven ability to analyze claims and enhance processing efficiency.
Overview
31
31
years of professional experience
Work History
Medical Claims Examiner
Intergrated Home Care Services Miramar, Fl
Miramar
10.2016 - 08.2019
- Reviewed medical claims for accuracy and compliance with regulations.
- Analyzed documentation to verify patient eligibility and coverage details.
- Processed claims using proprietary software for efficient workflow management.
- Communicated with healthcare providers to resolve claim inquiries and discrepancies.
- Coordinated with insurance companies to obtain necessary approvals for claims.
- Identified trends in claim denials to improve processing strategies.
- Collaborated with team members to ensure timely resolution of complex cases.
- Maintained detailed records of claims processed and outcomes achieved.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
Customer Service Representative
CSC Corporation - Albany, NY
Albany
08.2011 - 10.2016
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Resolved customer complaints through effective communication and problem-solving.
- Resolved customer issues with knowledgeable and friendly service, contributing to high levels of customer satisfaction.
- Assisted customers with inquiries and provided tailored product information to enhance their experience.
- Maintained accurate records of customer interactions and transactions to ensure seamless follow-up and service quality.
- Handled returns and exchanges while ensuring compliance with company procedures.
- Processed orders and managed customer accounts using CRM systems.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
Office Manager
Pitney Bowes
Boca Raton
09.1988 - 12.2005
- Facilitated interdepartmental communication to align project objectives.
- Managed daily office operations and maintained efficient workflow processes.
- Oversaw scheduling and organized meetings for executive leadership team.
- Organized filing systems for confidential documents, enhancing records management efficiency.
- Answered phone calls, responded to emails, routed mail and coordinated courier services.
- Monitored invoices and payments, ensuring accuracy of accounts receivable and payable.
- Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
- Ordered supplies and equipment to maintain adequate inventory levels.
Education
High School Diploma -
George Washington High School
New York, NY06-1978
Skills
- Claims processing
- Health insurance knowledge
- Data entry efficiency
- Attention to detail
- Customer relationship management
- Customer service
- Professional ethics
- Continuous learning mindset
- Patient care
- Health monitoring
- Effective communication
- Care plan implementation
- Home safety assessments
- Family caregiver education
- Emotional support
- Personal care services
- End-of-life care
- Intake recording
- Vital sign recording
- Bathing assistance
- Blood pressure measurement
Timeline
Medical Claims Examiner
Intergrated Home Care Services Miramar, Fl
10.2016 - 08.2019
Customer Service Representative
CSC Corporation - Albany, NY
08.2011 - 10.2016
Office Manager
Pitney Bowes
09.1988 - 12.2005
High School Diploma -
George Washington High School