Denise Abrego
Humble,TX
Summary
Experienced and detail-oriented Claims Specialist with a proven track record of effectively processing, managing, and resolving insurance claims. Seeking a remote position to leverage expertise in reviewing claim submissions, investigating issues, and ensuring accurate and timely resolution. Strong focus on attention to detail and exceptional organizational skills. Dedicated to providing efficient and reliable support to clients and colleagues. Committed to delivering high-quality results. Eager to contribute skills and knowledge to a dynamic team in the insurance industry.
Overview
16
16
years of professional experience
Work History
Claims Specialist
EA Renfroe
01.2021 - Current
- Processed a high volume incoming claims, ensuring proper coding, documentation, and compliance with company and regulatory standards
- Conduct follow-up with payers on open insurance claims and balances in compliance with departmental policies and procedures
- Verify patient insurance coverage, benefits, and authorization requirements for medical procedures and services
- Assisted with claim escalations and communicated with customers to explain claim decisions and next steps
- Documented all communications and outreach efforts in the company's claims management system
- Collaborated with insurance providers to resolve claim issues and discrepancies
Claims Specialist
Memorial Hermann Health System
05.2009 - 01.2021
- Processed and reviewed insurance claims for accuracy and compliance with company policies and insurance regulations
- Investigate and resolve issues related to claims, including missing information and discrepancies
- Maintain up-to-date knowledge of insurance policies, coverage types, and procedures to ensure accurate claim processing
- Collaborate with internal departments, including customer service and underwriting, to resolve claims and provide timely updates
- Communicate with claimants, policyholders, and external parties to gather necessary information and ensure proper claim submission
- Handle high-volume claims, ensuring all deadlines are met and claims are processed promptly
- Document in detail the problem or action and follow up with insurance companies until claims are paid
Skills
- Claims Management Software
- Communication Tools
- Office Software
- Insurance Knowledge
- Problem Resolution
Timeline
Claims Specialist
EA Renfroe
01.2021 - Current
Claims Specialist
Memorial Hermann Health System
05.2009 - 01.2021
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