Detail-oriented claims representative with extensive experience in claims processing and resolution. Proven ability to investigate claims accurately while maintaining professionalism and strong customer relationships.
Overview
24
24
years of professional experience
Work History
Senior Claims Representative
Povidence /St Joseph
Anaheim, California
11.2010 - 03.2024
Running reports, and reporting to banks on daily bases.
Responsible for processing and issue daily check run.
Research providers disputes, issue refunds, and recoup recoupments.
Evaluated claims for accuracy and compliance with company policies.
Investigated customer inquiries regarding claim status or payment accuracy.
Collaborated with team members to resolve complex claims issues effectively.
Reviewed and processed medical claims for accuracy and completeness.
Claims Service Representative
Bright Health Physicians of PIH
Whittier, CA
07.2000 - 09.2010
Processed claims for medical services with accuracy and efficiency.
Reviewed and validated claim submissions according to company guidelines.
Assisted team members in resolving complex claims issues effectively.
Trained new staff on claims processing protocols and best practices.
Adhered to all applicable laws, regulations, and company policies.
Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Organized information by using spreadsheets, databases or word processing applications.