Karen Herrera
220 Vista Loop, Davenport,FL
Summary
I wish to acquire a rewarding and challenging long-term position that will allow me an opportunity to utilize my abilities to their fullest potential while helping the company continue on a successful growth path. I am a reliable, honest and conscientious employee who can work with direct or indirect supervision. I wish to thrive in whatever challenges I may be given. I have over 25 years of experience in the Pharmacy/Medical/Life Claims Insurance, Customer Service & Hospitality Industries.
Overview
29
29
years of professional experience
Work History
Patient Care Advocate
Cigna/Accredo Specialty Pharmacy
10.2020 - 03.2024
- Acted as a liaison between Specialty Care Pharmacy, patients and the provider's office
- Communicated with patient or caregiver for prescription refills.
- Responsible for processing of prescription refills through pharmacy dispensing software
- Took over 100 phone calls a day with very low ACW and average handle time.
- Maintained 100% quality on calls every month.
Property Manager
Co Owner Vacation Homes Network
05.2014 - 03.2024
- Managed 50 or more vacation rental properties.
- Handled all the day to day operations for the company.
- Communicated with clients and tenants while offering strategic solutions to remedy problems.
- Kept records accurate, detailed and fully compliant with reporting requirements to meet all state, local and federal housing requirements.
- Handled disciplinary actions, performance appraisals and terminations of company staff.
- Maximized rental income while minimizing expenses through effective planning and control.
Senior Medical Claims Examiner/Customer Service Representative
American Trust Administrators
07.2000 - 05.2014
- Managed large volume of medical claims with a 98% accuracy on daily basis.
- Reviewed medical records, discounts & other pertinent information to help determine claims eligibility for payment or denial.
- Answered customer service calls on a daily basis by taking phone calls & helping the claimants with there questions or complaints.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Reviewed provider coding information to report services and verify correctness.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
- Trained & audited medical claims examiners.
Life Insurance Claims Examiner
Kansas City Life Insurance Co
04.2000 - 06.2000
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Identified suspicious losses.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to all issues.
- Assisted homeowners by coordinating the death benefits with the funeral services.
Medical Claims Examiner/Adjuster & Auditor
Centennial Life Insurance Co
07.1996 - 04.2000
- Reduced adjustment backlog by adjusting 30 to 40 claims a day when I was working the adjustments.
- Posted all recoveries to the correct accounts when received.
- Company was being liquidated so I performed any duties asked of me.
- Audited 35 to 40 claims a day when working on the audits.
- Achieved a 99.9% department audit from NOLHGA by auditing claims correctly.
- When processing medical claims I processed over 100 a day consistently exceeding my quota on a daily basis.
- Earned the privilege to work from home.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Paid or denied medical claims based upon established claims processing criteria.
Data Entry Clerk
Pyramid Life Insurance Company
01.1995 - 06.1996
- Keyed in over 500 medical claims on an average day for the medical claims examiners.
- Corrected any data entry error to prevent later issues such as duplication or data degradation.
- Entered client information into databases quickly and with minimal errors.
Education
High School Diploma -
Shawnee Mission North High School
Shawnee Mission, KS05.1987
Skills
- References provided upon request
Timeline
Patient Care Advocate
Cigna/Accredo Specialty Pharmacy
10.2020 - 03.2024
Property Manager
Co Owner Vacation Homes Network
05.2014 - 03.2024
Senior Medical Claims Examiner/Customer Service Representative
American Trust Administrators
07.2000 - 05.2014
Life Insurance Claims Examiner
Kansas City Life Insurance Co
04.2000 - 06.2000
Medical Claims Examiner/Adjuster & Auditor
Centennial Life Insurance Co
07.1996 - 04.2000
Data Entry Clerk
Pyramid Life Insurance Company
01.1995 - 06.1996
High School Diploma -
Shawnee Mission North High School
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