Anastasia Maisonet
Summary
Experienced with evaluating claims for accuracy and compliance. Utilizes strong organizational skills and attention to detail to process claims efficiently.
Overview
15
15
years of professional experience
Work History
Claims Representative
Elevance Health
01.2023 - Current
- As a Claims Rep I it is my responsibility to process claims according to the members benefits
- Worked productively in fast-moving work environment to process large volumes of claims.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
Claims Representative
Amerigroup / Anthem
03.2017 - 09.2019
- As claims representative it's my job to researches and analyzes claims issues and process claim for payment
- I also verified COB, eligibility, and authorization
- As needed I perform other duties as assigned
Customer Service Representative
Amerigroup Corporation
02.2014 - 02.2017
- As a customer service representative I assisted members and providers via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
- As a CSR it's my job to develop and maintain a positive member relation and coordinates with various functions within the company to ensure members requests and questions are handled appropriately and in a timely manner
Claims Specialist
Humana
08.2011 - 04.2013
- At Humana I assisted Current members on all aspects of there plan including answering questions regarding the plans features and benefits
- As well I provide accurate information regarding their eligibility status, provider network, authorization/referral status, and demographic changes
- Research claims for members and providers explaining how the claim was processed to ensure claim was processed correctly and to answer any question they may have regarding the claim
- Function as an information source through telephonic assistance to members, providers, various company/department staff
- Provide pleasant customer experience through superior customer service methods, problem-solving and real-time issue resolution
- Performs other duties as assigned
Customer Service Representative
Verizon Wireless
08.2010 - 08.2011
- Offer reassurance, support and resolution for our customers with billing questions, Technical support or other question they may have with their account or device
- I evaluate and modify accounts based on the customer's request and needs
- Demonstrated excellent verbal and written communication skills along with, reading and comprehension abilities
- Adheres to schedules and meeting all productivity, quality and performance standards
Sales Associate
Citi Bank
02.2010 - 10.2010
- Profiling customers to determine their needs, then cross-selling appropriate products and services
- Provide a broad base of services, including deposit-based, credit, and fee-based products, with the goal of acquiring all of the customers business
- Identifying additional opportunities to sell products and services to customers
- Experienced with interacting positively with difficult or hostile customers
- Self motivated, assertive, performs well in a team environment to service
- Professional, thorough and organized; able to follow standard operating policies and procedures
Education
High School Diploma -
Freedom High School
Tampa, FL05-2005
Skills
- Microsoft office
- Insurance claims review
- Claims investigation
- Time management
- Documentation research
- Claims processing
- Customer service
- Attention to detail
- Teamwork and collaboration
Timeline
Claims Representative
Elevance Health
01.2023 - Current
Claims Representative
Amerigroup / Anthem
03.2017 - 09.2019
Customer Service Representative
Amerigroup Corporation
02.2014 - 02.2017
Claims Specialist
Humana
08.2011 - 04.2013
Customer Service Representative
Verizon Wireless
08.2010 - 08.2011
Sales Associate
Citi Bank
02.2010 - 10.2010
High School Diploma -
Freedom High School