Summary
Overview
Work History
Education
Skills
Timeline
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Deborah Araiza

Riverside,CA

Summary

Detailed Claims Adjuster with 36 years of experience in Medical insurance claims. Dedicated Medical Claims professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level position. Ready to help team achieve company goals.

Overview

14
14
years of professional experience

Work History

Claims Adjuster

County Of Riverside
Riverside, CA
12.2013 - Current
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Managed large volume of medical claims on daily basis.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Responded to correspondence from insurance companies.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Reviewed provider coding information to report services and verify correctness.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Examined claims forms and other records to determine insurance coverage.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Processed EDI claims.
  • Processed Multi-Plan claims
  • Coordinated Benefits with other Medical Plans.
  • Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.
  • Prioritized daily tasks to satisfy workload demands and department's turnaround goals.
  • Researched issues related to claims processing to identify origins and implement corrective solutions.

Collector

Loma Linda University Health Care
Loma Linda, CA
12.2008 - 12.2013
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
  • Persistently reached out to customers with extremely past due accounts to recover lost revenue.
  • Contacted customers to discuss payment schedules and set up or immediately process payments.
  • Negotiated with account holders to devise repayment plans and minimize collections receivables.
  • Evaluated, researched and resolved discrepancies.
  • Achieved performance goals on consistent basis.
  • Used scripted conversation prompts to convey current account information and obtain payments.
  • Used skip tracing and other techniques to locate debtors.
  • Monitored accounts for compliance with established payment plans and flagged non-compliances.
  • Maintained high volume of calls and met demands of busy and productive group.
  • Managed past due collection calls, skip tracing, outside collections agency coordination and litigation activities.
  • Trained new collections representatives on collections processes and incentivized team members to achieve production goals.

Education

RN Pre-Requisites

San Bernardino Valley College
San Bernardino, CA

RN Prerequisites

Riverside City College
Riverside, CA

Medical Claims Examination

United Healthcare Careers College
San Bernardino, CA

Skills

  • Health Insurance Industry Knowledge
  • Claim Form Analysis
  • Healthcare Terminology
  • HIPAA Regulations
  • Medical Billing and Coding
  • Billing Procedures

Timeline

Claims Adjuster

County Of Riverside
12.2013 - Current

Collector

Loma Linda University Health Care
12.2008 - 12.2013

RN Pre-Requisites

San Bernardino Valley College

RN Prerequisites

Riverside City College

Medical Claims Examination

United Healthcare Careers College

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Deborah Araiza