Chantel Bonilla
Coral Springs,FL
Summary
Dedicated Claims Analyst with 4 years of experience in assessing claims, reviewing medical documentation, ensuring compliance with company policies, and regulations in a high-volume environment. Expert at managing a high caseload efficiently while maintaining accuracy and attention to detail.
Overview
9
9
years of professional experience
Work History
Claims Analyst
State Farm Insurance
10.2023 - Current
- Review and analyze claims to determine eligibility and benefit amounts
- Communicate effectively with claimants, healthcare providers, and internal stakeholders to gather necessary information
- Evaluate medical records, reports, and other documentation to make informed decisions
- Ensure compliance with state and federal regulations and company policies
- Maintain accurate records and documentation of all claim activities
- Provide excellent customer service and support to claimants throughout the claims process
- Mathematical aptitude to gather information, apply sound reasoning and draw appropriate conclusion.
Claims Analyst
Nuance Communications Inc (Microsoft)
09.2021 - 11.2023
- Exhibits a detailed knowledge of clinical documentation requirements and DRG assignment, medical terminology as well as a firm understanding of coding guidelines
- Reviews medical records using EPIC concurrently on a daily basis to identify opportunities to improve the quality and completeness of clinical documentation
- Facilitates modifications to clinical documentation when appropriate, through extensive concurrent interaction with physicians, mid-level providers, HIM staff, allied health professionals, and nursing staff to support accurate, complete, and timely documentation of clinical information in the electronic patient record
- Coached and educated physicians, mid-level providers, HIM staff, allied health professionals, and nurses on a daily basis to improve the capture of clinical severity for the level of service rendered to patients.
Claims Analyst
CVS Health
03.2015 - 09.2021
- Assisted Short Term Disability Analysts with administrative tasks related to claim processing
- Conducted initial reviews of incoming claims and organized documentation for analysis
- Communicated with claimants and healthcare providers to request additional information as needed
- Updated claim status and maintained databases to track claim progress
- Prepared reports and summaries for senior management and stakeholders
- Provide exceptional customer service by maintaining a dedication to meeting the expectations and requirements of internal and external customers
- Maintain a high-level of quality and accuracy while maintaining productivity targets in a fast-paced environment.
Education
B.S Healthcare Administration -
University of Phoenix
Currently Enrolled05.2027
High School Diploma -
Duluth High School
05.2014
Florida All-Lines adjuster (620) license -
10.2023
Skills
- Claims analysis
- Interpersonal and written communication
- Policy Interpretation
- Data Interpretation
Timeline
Claims Analyst
State Farm Insurance
10.2023 - Current
Claims Analyst
Nuance Communications Inc (Microsoft)
09.2021 - 11.2023
Claims Analyst
CVS Health
03.2015 - 09.2021
B.S Healthcare Administration -
University of Phoenix
High School Diploma -
Duluth High School
Florida All-Lines adjuster (620) license -
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