ERIN PUENTE
Senior Claim Analyst
Grand Island,NE
Summary
- Highly enthusiastic, customer service representative with 17 years of combined customer service. Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Resourceful professional promoting eight years of expertise assessing coverage and overseeing claims review. Leverages well-developed communication skills to deliver information to policyholders. Business-minded analyst with exemplary skills in customer service, time management and service coordination. Bringing over fifteen years of related experience combined with superior mathematical abilities. Pursuing similar position with an expanding company. I have a deep knowledge of group benefit claim industry. Excellent skills compiling, coding, categorizing and auditing information to process claims. Seeking and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Hardworking and passionate job seeker ready to help team achieve company goals. Experienced and successful at managing high caseloads in fast-paced environments. Offering dynamic organizational skills and attention to detail. Diligent and versed in insurance processes and claims procedures. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Hardworking and passionate job seeker with strong organizational skills eager to secure an available position. Ready to help any team achieve company goals.
Overview
19
19
years of professional experience
2
2
years of post-secondary education
Work History
Senior Claim Analyst-Dental
Principal Financial
Des Moines, IA
01.2015 - Current
- Remote employee based out of Des Moines IA; My current responsibilities include strong attention to detail, problem solving capabilities
- Accurately make decisions in a timely and effective manner pertaining to current State Laws, quality, timing and production
- Apply analytical skills to navigate through multiple online resources
- Fluent in Microsoft Office and most necessary applications.
- Maintained confidentiality of patient finances, records, and health statuses.
- Coordinated with contracting department to resolve payer issues.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Checked documentation for accuracy and validity on updated systems.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Verified client information by analyzing existing evidence on file.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Processed and recorded new policies and claims.
- Determined appropriateness of payers to protect organization and minimize risk.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Calculated adjustments, premiums and refunds.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Communicated verification and authorization status updates with Type department to facilitate decision-making for patient admissions and insurance coverage.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Posted payments to accounts and maintained records.
- Generated, posted and attached information to claim files.
- Modified, updated and processed existing policies.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strict confidentiality with all personal data as per company guidelines.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Identified key areas not performing well and implemented effective, new processes.
- Viewed reports regularly to make sure processing was conducted efficiently.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Maintained claims data in Type systems.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Examined claims forms and other records to determine insurance coverage.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Maintained suspicious claims database and prepared reports for supervisors.
- Identified suspicious losses and contacted manager for investigative assistance.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Bartender
Redline DC
Washington, DC
08.2012 - 02.2014
- Extensive experience in customer service and suggestive selling techniques
- Hands-on training and practice in making and serving popular, basic and fancy drinks as well as restaurant specific drink specialties
- Prevented store losses using awareness, attention to detail, and integrity
- Knowledge of liquors, beers, and wines
- Utilizing high levels of energy and multi-tasking abilities to quickly fill drink orders in an extremely fast-paced establishment
- Checking guests for proper identification, managing method of payment, and serving alcohol according to State, Federal, and corporate liquor regulations.
Hostess/Bartender
Mate Lounge
Washington, DC
04.2006 - 03.2012
- Helped create specialty cocktails to be featured on our menu
- Responsible for answering phone throughout shift to ensure prompt seating and floor management
- Trained new employees seasonally
- Organized sales reports for weekly meetings
- Created new processes and systems for increasing customer service satisfaction, such as suggesting the use of pos systems and additional pos systems.
Assistant to Property Manager
Weichert Reality
Arlington, VA
04.2004 - 04.2007
- Extensive experience in the real estate industry, and obtained my broker’s license
- Helped host open houses and manage real estate
- Managed office files and answered phone calls.
Education
Specialist In Psychology - Sociology And Anthropology
Mercy College
Dobbs Ferry, NY 08.2001 - 01.2004
High School Diploma - General
Bishop O'Connell High School
Arlington, VA 01.1998 - 1 2001
Skills
Document workflow
Claims
Skilled in Skygen
Claims review
Microsoft Word
Benefits review
Microsoft Office Suite
Microsoft Publisher
Coverage determination
Fair Isaac Claims Advisor
ClaimsPro
Valuation knowledge
Insurance policy coverage knowledge
Risk management
Additional Information
- AWARDS AND ACOMPLISHMENTS , First Team All-State and Second Team All-American, Softball, 2001 Player of the Year, Softball, 2001 Awarded All-American by NFCA in 2002 Traveled abroad throughout South America and Europe in 2007 and again in 2010.
Timeline
Senior Claim Analyst-Dental
Principal Financial
01.2015 - Current
Bartender
Redline DC
08.2012 - 02.2014
Hostess/Bartender
Mate Lounge
04.2006 - 03.2012
Assistant to Property Manager
Weichert Reality
04.2004 - 04.2007
Specialist In Psychology - Sociology And Anthropology
Mercy College
08.2001 - 01.2004
High School Diploma - General
Bishop O'Connell High School
01.1998 - 1 2001