Karina Ramirez
Albuquerque
Summary
Detail-oriented professional driven to resolve claims fairly while representing interests of employer. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy diverse parties. Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.
Overview
2026
2026
years of professional experience
1
1
year of post-secondary education
Work History
Claims Specialist
Presbyterian
Albuquerque
01.2013 - 10.2025
- Processed claims accurately and in a timely manner.
- Coordinate dual coverage.
- Process adjustments to correct claims.
- Worked different line on business according to benefits.
- Coordinated with internal departments to ensure timely resolution of complex claims.
- Resolved claims by approving or denying documentation and calculating benefits.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
Claims specialist
Blue Cross and Blue Shield
- Reviewed insurance claims for accuracy and completeness.
- Communicated with clients to gather necessary documentation.
- Investigated claim discrepancies and resolved issues promptly.
Education
Certificate - Medical Officer Administration
El Paso Vocational School
El Paso, TX 01.2002 - 03.2003
Skills
- Claims processing
- Policy interpretation
- Benefits calculation
- Coverage coordination
Languages
Spanish
Beginner
Timeline
Claims Specialist
Presbyterian
01.2013 - 10.2025
Certificate - Medical Officer Administration
El Paso Vocational School
01.2002 - 03.2003
Claims specialist
Blue Cross and Blue Shield