Celeste Salinas
Odessa
Summary
Detail-oriented Insurance Claims Specialist with strong skills in claim analysis, policy interpretation, and fraud investigation. Known for effective communication and problem-solving abilities, driving efficient claims resolution and compliance.
Overview
3
3
years of professional experience
Work History
Insurance Claims Specialist
Jose Benigno, M.D.
Odessa
04.2015 - 05.2018
- Reviewed and verified insurance claims for accuracy and compliance with policy guidelines.
- Identified discrepancies in claims submissions and initiated corrective actions.
- Documented claim activities and maintained organized records for audit purposes.
- Established relationships with external partners to expedite claims resolution.
- Calculated benefit payments based on policy terms, coverage limits, and applicable regulations.
- Maintained detailed records of all claim activities including correspondence, decisions, payments.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Investigated suspicious or fraudulent claims and reported findings to management.
- Prepared reports summarizing claim activity for senior management review.
Education
High School Diploma -
Career Center
Odessa, TX05-2001
Some College (No Degree) - Computer Science
University of Texas At Permian Basin
Odessa, TXSkills
- Claim analysis
- Policy interpretation
- Fraud investigation
- Documentation management
- Insurance regulations
- Problem solving
- Attention to detail
- Effective communication
- Time management
- Conflict resolution
- Detail orientation
- Claims investigation
- Medical terminology
- Computer proficiency
- Medicaid
- Claims preparation
- Multitasking Abilities
- Insurance plan verification
- Great mathematical skills
- Documentation processing
- Allocating claims
- Recordkeeping organization
- Organizing and prioritizing work
- Communication skills
- Confidentiality maintenance
- Time management abilities
- Reliability
- Professionalism
- Active listening
- Research skills
Timeline
Insurance Claims Specialist
Jose Benigno, M.D.
04.2015 - 05.2018
High School Diploma -
Career Center
Some College (No Degree) - Computer Science
University of Texas At Permian Basin