Elisa Fernando
Washington,NJ
Summary
Experienced Claims Specialist with over 10+ years of Strong problem-solving skills and excellent customer service. Efficient professional in insurance claims and policy processing, known for high productivity and the ability to complete tasks with precision. Specialized in analyzing claim details, navigating policy databases. Excel in problem-solving, adaptability, and teamwork, leveraging these soft skills to navigate complex situations and achieve positive outcomes.
Overview
31
31
years of professional experience
Work History
Claims Pend Specialist
Horizon Blue Cross Blue Shield of NJ
Newark, New Jersey
11.1993 - Current
- Proficient in processing COB/Medicare claims, with full knowledge of the member's benefits, while consistently maintaining a high rating in quality and production.
- Responsible for processing VIP claims assigned by my Manager/Team leader.
- Participated in a wide variety of projects, including the recent FDE SWAT team, and inventory reduction.
- Provided exceptional customer service to maintain positive relationships with all parties.
- Collaborated with other departments within the organization to resolve issues related to claims processing.
- Handles the Team's flush requests and claims stops like the E912.
- Ensured compliance with state laws governing insurance practices as well as company policies and procedures.
- Collaborated with fellow team members to manage large volume of claims.
- Prioritized and organized tasks to efficiently accomplish service goals.
Education
Bachelor of Science - Nursing
St Jude College of Manila
Philippines 03-1993
Skills
- Issue Resolution
- Claims investigation
- Claims analysis
- Active listening
- Problem-solving
- Organizing and prioritizing work
- Teamwork and collaboration
- Continuous improvement
Timeline
Claims Pend Specialist
Horizon Blue Cross Blue Shield of NJ
11.1993 - Current
Bachelor of Science - Nursing
St Jude College of Manila
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