Summary
Overview
Work History
Education
Skills
Timeline
Generic

Esther Valenzuela

Pico Rivera,CA

Summary

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.

Education

Medical Receptionist / Scheduler

Whittier Adult School
Whittier, CA

High School Diploma -

El Rancho High School
Pico Rivera, CA

Skills

  • Claims processing
  • Appointment scheduling
  • Professionalism
  • Claims adjustment
  • Multitasking capacity
  • Multi-tasking
  • Claims resolution
  • Claims investigation
  • Attention to detail
  • Problem solving
  • Critical thinking
  • Time management
  • Customer relationship management

Timeline

Senior Claims Representative

Povidence /St Joseph
11.2010 - 03.2024

Claims Service Representative

Bright Health Physicians of PIH
07.2000 - 09.2010

Medical Receptionist / Scheduler

Whittier Adult School

High School Diploma -

El Rancho High School
Esther Valenzuela