Ashley Nino
Houston,TX
Summary
Dynamic proven expertise, enhancing claims processing efficiency through critical thinking and collaboration. Recognized for implementing process improvements that reduced turnaround times and elevated customer satisfaction. Skilled in claims analysis and dedicated to delivering exceptional service while maintaining compliance with industry regulations.
Overview
2027
2027
years of professional experience
Work History
Claims Representative
MMR Solution
09.2024 - Current
- Processed claims efficiently, ensuring compliance with policies and regulations.
- Assisted customers in understanding claim processes and requirements.
- Reviewed and evaluated claim documentation for accuracy and completeness.
- Coordinated with internal departments to resolve claim-related issues promptly.
- Maintained detailed records of claims activity and customer interactions.
- Analyzed trends in claims data to identify areas for process improvement.
- Trained new team members on claims processing procedures and systems.
- Followed up with customers on unresolved issues.
- Collected premiums and issued accurate receipts.
- Maintained confidentiality of patient finances, records, and health statuses.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Calculated adjustments, premiums and refunds.
- Processed invoices and billing statements with attention to detail.
- Assisted in maintaining accurate billing records and documentation.
- Processed medical claims accurately and efficiently, ensuring timely reimbursement.
- Verified insurance of patients to determine eligibility.
Insurance Claims Specialist
Spring Hospital
05.2022 - 08.2024
- Processed insurance claims efficiently, ensuring adherence to hospital policies and procedures.
- Reviewed claim submissions for accuracy, identifying discrepancies and initiating necessary corrections.
- Collaborated with healthcare providers to gather required documentation for claims processing.
- Managed claims appeals by analyzing denials and preparing comprehensive responses to insurance carriers.
- Trained new team members on claims processing protocols and system navigation for optimal performance.
- Utilized claims management software to track progress and maintain organized documentation of all transactions.
- Implemented process improvements that enhanced claim turnaround times and reduced errors in submissions.
- Strengthened client relationships by providing clear communication throughout the claims process, ensuring all parties were well-informed of progress and outcomes.
- Enhanced customer satisfaction by efficiently managing insurance claims processes and providing timely resolutions.
- Followed up with customers on unresolved issues.
- Posted payments to accounts and maintained records.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Claims Specialist
Advanced Revenue Management
10.2018 - 05.2022
- Evaluated and processed insurance claims to ensure compliance with company policies and procedures.
- Liaised with clients and adjusters to gather necessary documentation for claims resolution.
- Analyzed claim data to identify trends and recommend process improvements for efficiency.
- Implemented workflow enhancements that reduced claim processing times significantly.
- Collaborated with cross-functional teams to resolve complex claims issues effectively.
- Conducted training sessions for new hires on claims management systems and procedures.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
Claims Specialist
Medical Practice Solution
- Analyzed claims to ensure compliance with company policies and regulations
- Reviewed documentation for accuracy, identifying discrepancies and initiating resolutions
- Collaborated with cross-functional teams to streamline claims processing procedures
- Trained new staff on claims management systems and best practices
- Implemented process improvements to enhance efficiency in claims handling
- Conducted audits of processed claims to maintain quality standards
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Delivered comprehensive training sessions for new hires on claims handling procedures, policy interpretation basics, negotiation techniques, and other core competencies related to the role of a Claims Specialist.
Administrative Assistant
Sis Group
- Managed scheduling and calendar coordination for multiple executives.
- Prepared and organized documentation for meetings and presentations.
- Assisted in maintaining office supplies inventory and procurement processes.
- Streamlined communication between departments to enhance workflow efficiency.
- Handled incoming correspondence, prioritizing urgent requests for timely responses.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
- Delivered excellent customer service through prompt responses to client inquiries, addressing concerns effectively, and building strong relationships.
- Ensured accurate record-keeping with diligent data entry and database management for vital company information.
- Promoted a positive work environment through effective communication skills and fostering professional relationships among colleagues.
- Improved document organization with thorough file maintenance, archiving outdated records as necessary for efficient retrieval when needed.
- Coordinated office supply inventory management, proactively ordering necessary items before depletion to avoid workflow disruptions.
- Supported executive staff through scheduling meetings, coordinating travel arrangements, and preparing crucial documents.
- Assisted with human resources tasks such as updating employee files or submitting time-off requests per company policy guidelines.
- Assisted in onboarding new employees, providing training materials, and coordinating orientation schedules to ensure a smooth integration into the team.
- Volunteered to help with special projects of varying degrees of complexity.
- Opened and properly distributed incoming mail to promote quicker response to client inquiries.
- Interacted with vendors, contractors and professional services personnel to receive orders, direct activities, and communicate instructions.
Receptionist to Warehouse Worker
Beauty Elite Group
- Managed front desk operations, greeting visitors and answering phone inquiries.
- Scheduled appointments for clients, optimizing daily workflow and resource allocation.
- Maintained accurate records of client interactions and appointments using scheduling software.
- Assisted in processing payments and managing financial transactions with precision.
- Developed strong relationships with clients through exceptional customer service and follow-up communication.
- Trained new staff on front desk procedures and company policies to ensure consistency in service delivery.
- Answered phone promptly and directed incoming calls to correct offices.
- Kept reception area clean and neat to give visitors positive first impression.
- Resolved customer problems and complaints.
- Handled cash transactions and maintained sales and payments records accurately.
- Streamlined front desk operations for increased efficiency by effectively managing phone calls, emails, and walk-in clients.
- Operated warehouse equipment to efficiently fulfill orders and maintain inventory accuracy.
- Assisted in unloading and sorting incoming shipments to streamline warehouse processes.
- Maintained cleanliness and organization of work areas to ensure safety and compliance.
- Collaborated with team members to enhance workflow efficiency during peak operational periods.
- Operated moving truck safely to deliver items to destination without nicks or scratches.
- Streamlined material delivery processes which increased efficiency and reduced downtime.
- Verified documentation and condition of freight to assure quality standards were achieved.
- Strapped items down over protective padding to secure throughout transportation.
- Successfully navigated large shipments of materials through tight spaces and busy facilities.
- Managed warehouse operations and verified proper shipment procedures.
- Drove forklifts, pallet jacks and other equipment to move materials.
- Used machinery and equipment such as box cutters, shrink-wrap guns and electric pallet jacks.
- Shipped material and performed boxing, packing, labeling, and preparation of related documents.
- Maintained clean, orderly work environment free of hazards.
- Loaded and unloaded materials onto and off of trucks for fast shipment.
- Enhanced physical inventory counts, participating in semi-annual audits to verify stock levels.
Education
High School Diploma -
Humble High School
Humble, TXCriminal Justice
South University Savannah
GASkills
- Claims
- Claims processing
- Claims investigation
- Verbal communication
- Microsoft office
- Claims analysis
- Documentation review
- Claims trend analysis
- Allocating claims
- Decision-making
- Critical thinking
- Customer service
- Organizing and prioritizing work
- Attention to detail
- Teamwork and collaboration
- Multitasking Abilities
- Problem-solving
- Insurance coverage verification
- Claims adjustment
- Team building
- Eligibility determination
- Active listening
- Data entry
- Skilled in Software
- Proficient in Software
- HIPAA compliance
- Insurance verification
- Insurance verifying
- Time management
- Listening skills
- Cash handling
- Telephone etiquette
- Supervisory experience
- Inventory control
Timeline
Claims Representative
MMR Solution
09.2024 - Current
Insurance Claims Specialist
Spring Hospital
05.2022 - 08.2024
Claims Specialist
Advanced Revenue Management
10.2018 - 05.2022
Claims Specialist
Medical Practice Solution
Administrative Assistant
Sis Group
Receptionist to Warehouse Worker
Beauty Elite Group
High School Diploma -
Humble High School
Criminal Justice
South University Savannah