Edna Gomez Stephens
Kissimme,FL
Summary
Dynamic Claims Associate with extensive experience at State Farm, excelling in claims processing and conflict resolution. Proven ability to investigate claims and interpret policies, achieving financial targets through meticulous documentation review. Strong collaborator with a solid foundation in data analysis, dedicated to enhancing customer satisfaction and operational efficiency.
Overview
5
5
years of professional experience
Work History
Claims Associate
State Farm
11.2023 - Current
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Collaborated with internal departments and external vendors to resolve claims.
- Developed in-depth understanding of insurance policies and procedures.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Checked documentation for accuracy and validity on updated systems.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Posted payments to accounts and maintained records.
Medical Assistant
IMA
01.2021 - 08.2023
- Obtained client medical history, medication information, symptoms, and allergies.
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Explained procedures to patients to reduce anxieties and increase patient cooperation.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Prepared lab specimens for diagnostic evaluation.
- Obtained and documented patient medical history, vital signs and current complaints at intake.
Education
High School Diploma -
Escuela Vocacional Manuel Mediavilla Negron
Humacao, PR05-2009
Skills
- Claims investigation
- Policy interpretation
- Claims
- Claims processing
- Documentation research
- Conflict resolution
- File management
- Accident review
- Team collaboration
- Microsoft office
- Documentation review
- Data analysis
- Check-in coordination
- Medical office administration
- Patient-focused care
- Phlebotomy
- Intake control
- Medical records management
- Patient flow management
- Lab equipment operation
- Vital signs monitoring
- Case management
- Conversant in Spanish
- Inventory management
- Patient scheduling
- Lab equipment calibration
- EMR / EHR
Languages
Spanish
Native or Bilingual
Timeline
Claims Associate
State Farm
11.2023 - Current
Medical Assistant
IMA
01.2021 - 08.2023
High School Diploma -
Escuela Vocacional Manuel Mediavilla Negron