DANIEL ORTIZ
ATLANTA
Summary
Dynamic and results-driven professional with over 8 years of experience in managing complex processes and ensuring compliance as a Claims Processor. Demonstrated expertise in handling high-volume workloads while coordinating with multiple stakeholders to drive timely resolutions and manage detailed documentation. Aiming to leverage strong analytical and program management skills to effectively execute and support key initiatives in the Program Coordinator role at Amerit Fleet Solutions. Committed to enhancing operational efficiency and fostering collaboration to achieve organizational goals.
Overview
8
8
years of professional experience
Work History
CLAIMS PROCESSOR
Openly, LLC
04.2023 - Current
- Reviewed and analyzed insurance claims for accuracy and compliance with company policies.
- Processed high volume of claims efficiently, maintaining attention to detail throughout workflow.
- Collaborated with adjusters to resolve discrepancies and expedite claim processing timelines.
- Utilized industry-specific software to track, document, and manage claims effectively.
- Trained new staff on claims processing procedures, enhancing team performance and knowledge sharing.
- Developed process improvement initiatives that streamlined workflow and reduced turnaround times for claims approval.
MEDICAL CLAIMS ADJUSTER
Builders Insurance Group
01.2019 - 04.2023
- Assessed medical claims, ensuring compliance and accuracy, reducing errors significantly.
- Collaborated with healthcare providers to resolve disputes, enhancing claim processing efficiency.
- Analyzed complex cases, applying industry knowledge to achieve fair settlements and client satisfaction.
- Processed complex medical claims, implemented streamlined documentation protocols, and coordinated with healthcare providers to resolve coverage disputes
- Reviewed and validated medical documentation, ensuring compliance with insurance policies while maintaining accurate claim records
- Managed high-volume caseload while reducing processing time through efficient claim evaluation and systematic investigation procedures
MEDICAL CLAIMS SERVICE REP
Builders Insurance Group
11.2017 - 01.2019
- Processed medical claims with meticulous attention to detail, resolving complex insurance cases while maintaining compliance with healthcare regulations.
- Assisted clients through claims procedures, provided clear explanations of benefits, and facilitated timely resolution of coverage disputes.
- Streamlined claims processing workflow, reducing average resolution time while maintaining high accuracy standards and customer satisfaction.
- Managed comprehensive documentation for medical claims, ensuring accurate record-keeping and swift processing of insurance benefits.
- Coordinated with healthcare providers and insurance adjusters to expedite claims processing and optimize client service delivery.
- Analyzed complex medical claims data to identify patterns and resolve coverage disputes, while maintaining strict compliance with healthcare regulations.
Education
MBA - BUSINESS ADMINISTRATION
Western Governors University
Salt Lake City, UT02-2025
BACHELOR'S DEGREE - BUSINESS ADMINISTRATION
Western Governors University
Salt Lake City, UT08.2024
Skills
- Office administration
- Proactive mindset
- Strategic planning
- Process improvements
- Project management
- Training coordination
- Accuracy and precision
- Professionalism and ethics
- Technical aptitude
- Data entry proficiency
- Bilingual
- Attention to detail
LANGUAGES
English (Native), Spanish (Native).
Timeline
CLAIMS PROCESSOR
Openly, LLC
04.2023 - Current
MEDICAL CLAIMS ADJUSTER
Builders Insurance Group
01.2019 - 04.2023
MEDICAL CLAIMS SERVICE REP
Builders Insurance Group
11.2017 - 01.2019
MBA - BUSINESS ADMINISTRATION
Western Governors University
BACHELOR'S DEGREE - BUSINESS ADMINISTRATION
Western Governors University
LINKS
LinkedIn: www.linkedin.com/in/daniel-ortiz-336ba9178
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