Summary
Overview
Work History
Education
Skills
Accomplishments
Languages
Work Preference
Timeline
Receptionist
Open To Work

Belle Son

San Antonio,TX

Summary

Dynamic Medical Claims Resolution Specialist at FCE Benefit Administrators, Inc. with a proven track record in enhancing refund posting efficiency, auditing, medical claims processing, resolving discrepancies, and fostering strong client relationships while also processing short-term disability benefits for all employees. Skilled in advanced Excel offices and problem-solving, I implemented process improvements that streamlined workflows, achieving timely resolutions and maintaining meticulous documentation for HIPAA regulations and compliance.

Responsible individual with strong attention to detail and juggles multiple tasks. Known for strong team collaboration, adaptability, and commitment to achieving results. Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement.

Overview

6
6
years of professional experience

Work History

Refund Specialist

FCE Benefit Administrators, Inc.
02.2023 - Current
  • Managed high-volume refund transactions using advanced financial software systems.
  • Processed refund requests efficiently, ensuring compliance with company policies and procedures.
  • Followed up on denied and unpaid claims to resolve problems and obtain payments.
  • Actively contributed to team discussions on best practices for handling unique or challenging refund scenarios, sharing practical insights gained from experience.
  • Assisted management in developing a comprehensive policy manual outlining clear guidelines for handling refunds, overpaid claims, and related issues.
  • Utilized advanced Excel skills for organizing large datasets pertaining to refunds processed, enabling quick retrieval of relevant information when needed.
  • Maintained accurate records of all refunds processed, ensuring proper documentation for auditing purposes.
  • Collaborated with sales and finance teams to resolve complex refund cases, resulting in improved client relationships.
  • Used data entry skills to accurately document and input statements.
  • Generated monthly billing and posting reports for management review.
  • Reconciled accounts receivable to general ledger.
  • Developed training materials for new staff, enhancing understanding of refund processes and systems.
  • Conducted regular audits of refund transactions to ensure accuracy and reduce discrepancies.
  • Implemented process improvements that increased overall efficiency in the refund processing workflow.
  • Prepared monthly, quarterly and annual reports.
  • Supported financial director with special projects and additional job duties.
  • Created improved filing system to maintain secure client data.

Short-Term Disability Claims Specialist

FCE Benefit Administrators, Inc.
01.2023 - Current
  • Collaborated with healthcare providers, the employees, and clients to gather necessary documentation for claims processing.
  • Assisted employees in understanding their benefits and claim processes, enhancing customer satisfaction.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Checked documentation for accuracy and validity on updated systems.
  • Processed and recorded new policies and claims.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Analyzed case files to identify discrepancies and recommend resolutions for efficient claims handling.
  • Led initiatives to streamline claim review processes, resulting in improved turnaround times.
  • Conducted comprehensive evaluations to determine eligibility for benefits, ensuring compliance with company policies and government regulations.
  • Enhanced customer satisfaction with timely communication and empathetic support during the claims process.
  • Managed high caseloads effectively, ensuring all disability claims were processed promptly and accurately.
  • Demonstrated attention to detail when reviewing medical records, enabling accurate assessment of functional limitations caused by disabilities.
  • Provided exceptional service to clients through prompt response times, clear explanations of policy terms, and compassionate support throughout the claims process.
  • Played a critical role in resolving customer complaints by addressing concerns and providing clear explanations about claim decisions, maintaining positive relationships with clients.
  • Reduced claim processing time by conducting thorough assessments and providing accurate documentation for each case.
  • Mentored new team members on best practices for claims assessment and dispute resolution strategies.
  • Developed training materials to enhance staff knowledge on regulatory changes affecting disability claims.
  • Assisted in creating training materials for new staff members that led to increased understanding of company policies and procedures related to disability claims management.
  • Improved claim processing efficiency by streamlining workflow procedures.
  • Mentored junior team members in handling complex cases, resulting in better decision-making and improved overall team performance.
  • Supported the development of new claims management software, providing valuable input based on experience and expertise in disability claims handling.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Posted payments to accounts and maintained records.
  • Modified, updated and processed existing policies.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.

Medical Benefits Coordinator

FCE Benefit Administrators, Inc.
06.2024 - 07.2025
  • Administered employee benefits programs ensuring compliance with regulations and organizational policies.
  • Coordinated open enrollment processes, providing guidance to employees on benefit options and selections.
  • Managed communication between employees and clients, resolving inquiries effectively.
  • Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
  • Served as primary point of contact for employee benefits inquiries, resolving issues promptly and accurately.
  • Coordinated open enrollment events to educate employees on benefit options and encourage informed decisionmaking.
  • Coordinated and managed all aspects of annual benefit plan renewals-ensuring a seamless transition for employees while minimizing disruption to ongoing operations.
  • Enhanced employee satisfaction by efficiently administering and managing benefits programs.
  • Managed leave administration process, including FMLA requests, ensuring proper documentation and communication with employees.
  • Conducted regular audits of benefits data to identify discrepancies, ensuring accurate reporting and timely resolution of errors.
  • Developed comprehensive benefits communications materials, resulting in increased employee understanding of available offerings.
  • Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and Microsoft Teams interactions.

Medical Claims Examiner

FCE Benefit Administrators, Inc.
06.2020 - Current
  • Evaluated medical claims for accuracy and compliance with regulations and policies.
  • Reviewed documentation to determine eligibility and appropriateness of services rendered.
  • Conducted audits of processed claims to identify discrepancies and ensure adherence to guidelines.
  • Collaborated with healthcare providers and clients to resolve claim issues efficiently.
  • Implemented process improvements that enhanced claim review efficiency and reduced turnaround time.
  • Analyzed trends in claim submissions to recommend policy adjustments for risk mitigation.
  • Led initiatives focused on improving customer service related to claims inquiries and resolutions.
  • Improved interdepartmental communication by fostering a collaborative environment and sharing vital information regarding complex cases.
  • Implemented quality control measures to detect potential issues early on, preventing costly mistakes or delays in payment processing timeframes.
  • Reduced errors in claim submissions by meticulously reviewing patient information and verifying insurance eligibility.
  • Continuously sought opportunities for process improvement, contributing innovative ideas to enhance overall departmental efficiency and effectiveness.
  • Processed insurance payments and maintained accurate documentation of payments.
  • Examined claims forms and other records to determine insurance coverage.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Analyzed information and reported findings and recommendations.
  • Verified patient insurance coverage and benefits for medical claims.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Identified and resolved discrepancies between patient information and claims data.

Medical Claims Specialist

FCE Benefit Administrators, Inc.
11.2019 - Current
  • Assisted in processing medical claims for accuracy and compliance with insurance regulations.
  • Researched claim denials to identify errors and facilitate resolutions.
  • Supported documentation efforts by compiling necessary patient information and medical records.
  • Collaborated with healthcare providers to clarify claim details and expedite approval processes.
  • Provided exceptional customer service by addressing patient inquiries regarding claim status and procedures.
  • Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
  • Improved claim processing efficiency by streamlining workflows and implementing best practices.
  • Maintained accurate patient records by diligently updating databases and following strict documentation guidelines.
  • Monitored outstanding accounts receivable balances for trends that could indicate payer issues or potential collection problems.
  • Conducted regular audits of processed claims to identify areas for improvement and potential fraud risks.
  • Achieved timely reimbursements for clients through keen understanding of insurance company protocols.
  • Optimized workflow processes by identifying bottlenecks within the system, implementing necessary changes for increased efficiency.
  • Utilized advanced knowledge of ICD-10 codes, CPT codes,and Modifiers to accurately process claims.
  • Effectively resolved claim disputes by conducting thorough investigations and presenting findings to stakeholders clearly and concisely.
  • Collaborated with interdisciplinary teams to ensure smooth processing and accurate reimbursement of medical claims.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Verified patient insurance coverage and benefits for medical claims.
  • Monitored and updated claims status in claims processing system.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Generated reports on medical claims processing activities and results.
  • Identified and resolved discrepancies between patient information and claims data.
  • Checked documentation for accuracy and validity on updated systems.
  • Processed and recorded new policies and claims.
  • Generated, posted and attached information to claim files.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Posted payments to accounts and maintained records.
  • Calculated claims adjustments and refunds.
  • Modified, updated and processed existing policies.
  • Communicated effectively with staff members of operations, finance and benefit eligibility departments.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Coordinated with finance department to resolve payer issues.

Education

High School Diploma -

Somerset High School
Somerset, TX
06-2012

Skills

  • Refund processing
  • Problem-solving
  • Time management
  • Attention to detail
  • Organizational skills
  • Adaptability and flexibility
  • Decision-making
  • Professional communication
  • Relationship building
  • General accounting
  • Paperwork and documentation
  • Microsoft office
  • Task prioritization
  • Work Planning and Prioritization
  • Self motivation
  • Analytical thinking
  • Goal setting
  • Professionalism

Accomplishments

  • Received two promotions from my director within my 90 days and less than 3 months of employment with the company.
  • Maintained overdue project tasks and audit requests.
  • Used Microsoft Excel and Sharepoint to develop inventory tracking spreadsheets.
  • Managed the Resolution Specialists team of 5 staff members.
  • Redesigned internal training materials to enhance engagement, interactivity, and knowledge retention.

Languages

English
Full Professional

Work Preference

Job Search Status

Open to work

Work Type

Full TimeContract WorkPart Time

Location Preference

Remote

Salary Range

$55000/yr - $200000/yr

Timeline

Medical Benefits Coordinator

FCE Benefit Administrators, Inc.
06.2024 - 07.2025

Refund Specialist

FCE Benefit Administrators, Inc.
02.2023 - Current

Short-Term Disability Claims Specialist

FCE Benefit Administrators, Inc.
01.2023 - Current

Medical Claims Examiner

FCE Benefit Administrators, Inc.
06.2020 - Current

Medical Claims Specialist

FCE Benefit Administrators, Inc.
11.2019 - Current

High School Diploma -

Somerset High School

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