FACETS
Elena Serafino
Claims Examiner II
Dedham,MA
Summary
Claims Examiner with deep knowledge of Health Insurance claims industry. Solid abilities in developing objectives and strategies to settle multiple types of claims. (e.g. Fraud, COB, DME, Workers Comp, Dental, Vision, Medicare, Physician, Behavioral Health, Fraud claims, Inpatient & Outpatient Hospital, and many more.) Excellent skills compiling, coding, categorizing and auditing information to process claims.
Overview
4
4
years of professional experience
4
4
years of post-secondary education
Work History
Claims Examiner II
BlueCross BlueShield Of Tennessee
Chattanooga , Tennessee
08.2018 - 07.2020
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems.
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Processed insurance payments and maintained accurate documentation of payments.
- Paid or denied medical claims based upon established claims processing criteria.
- Reviewed provider coding information to report services and verify correctness.
- Followed up on denied claims to verify timely patient payment and resolution.
Meals Clerk - Aprons
Publix Supermarkets Store
Chattanooga , Tennessee
04.2017 - 07.2018
- Changed and sanitized cutting boards, benches, and surfaces between tasks to avoid cross-contamination.
- Prepared food items in compliance with recipes and portioning control guidelines.
- Prepared multiple orders simultaneously during peak periods with high accuracy rate, maximizing customer satisfaction, and repeat business.
- Checked for quality, kept track of old and new items and rotated stock to confirm freshness of food and ingredients.
- Set up and prepared cooking supplies and workstations during opening and closing to maximize productivity.
- Maintained well-stocked stations with supplies and spices for maximum productivity.
Cashier
Publix Supermarkets Store
Chattanooga , Tennessee
02.2016 - 04.2017
- Answered questions about store policies and addressed customer concerns.
- Addressed customer needs and made product recommendations to increase sales.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Restocked and organized merchandise in front lanes.
- Helped customers complete purchases, locate items, and join reward programs.
Education
High School Diploma -
Spanish River High School
Boca Raton, Florida 08.2013 - 05.2017
Skills
Health insurance industry knowledge
undefinedAdditional Information
Unfortunately, due to the pandemic and quarantine, I was unable to work from July 2020-2022. Shortly after quarantine ended, I ended up getting sick that affected me to where I could not work. Over the year, I have fortunately recovered to where I can start working again. I am very eager to start working again, and get back on my feet. I have been actively searching for a job, and would love the opportunity to be apart of your team!
Software
Coding
Timeline
Claims Examiner II
BlueCross BlueShield Of Tennessee
08.2018 - 07.2020
Meals Clerk - Aprons
Publix Supermarkets Store
04.2017 - 07.2018
Cashier
Publix Supermarkets Store
02.2016 - 04.2017
High School Diploma -
Spanish River High School
08.2013 - 05.2017
Similar Profiles
Nicole T. WithersNicole T. Withers
Benefit Representative at BlueCross BlueShield of TennesseeBenefit Representative at BlueCross BlueShield of Tennessee
BENJAMIN R. SARTINBENJAMIN R. SARTIN
eBusiness Support Specialist at BlueCross BlueShield of TennesseeeBusiness Support Specialist at BlueCross BlueShield of Tennessee
Nicole T. WithersNicole T. Withers
Benefit Representative- Remote at BlueCross BlueShield of TennesseeBenefit Representative- Remote at BlueCross BlueShield of Tennessee