Karmin Norales
Bronx,NY
Summary
Claims Manager with extensive experience at Bellevue Hospital Center, recognized for improving claims processing efficiency through innovative operational strategies. Expertise in claims evaluation and negotiation, leading teams to achieve timely resolutions and high customer satisfaction. Strong commitment to compliance and quality assurance in all claims management activities.
Overview
14
14
years of professional experience
Work History
Claims Manager
Bellevue Hospital Center
06.2019 - Current
- Ensured accuracy and completeness of claims through thorough evaluation.
- Streamlined processing of insurance claims, improving team efficiency.
- Gained understanding of regulatory requirements essential for claims management.
- Worked closely with cross-functional teams to effectively address claim disputes.
- Documented claims meticulously for auditing and compliance purposes.
- Streamlined communication between adjusters and clients, expediting claim resolution times.
- Enhanced customer satisfaction with timely and accurate claims resolutions.
- Managed a team of adjusters, providing coaching and performance feedback for improved productivity.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
- Negotiated settlements with claimants, achieving fair outcomes while controlling costs.
- Improved claims processing efficiency by implementing streamlined workflow procedures.
Assistant Claims Manager
Bellevue Hospital Center
07.2014 - 06.2019
- Adjudicated claims while ensuring strict adherence to hospital policies.
- Worked closely with medical staff to obtain documentation necessary for claims resolution.
- Boosted efficiency and accuracy of claims handling through workflow improvements.
- Provided training to junior staff on best practices and claims procedures.
- Managed complex claim inquiries by liaising with insurance companies and patients.
- Compiled training materials aimed at improving onboarding processes for new hires in the claims department.
- Supported audits by monitoring compliance with regulatory standards, enhancing quality assurance efforts.
Claims Specialist
Metropolitan Hospital Center
01.2012 - 07.2014
- Processed insurance claims for accuracy and adherence to hospital policies.
- Collaborated with medical personnel to gather essential documentation for submissions.
- Investigated claims payment discrepancies, ensuring swift issue resolution.
- Maintained comprehensive records of activities and communications with patients and insurers.
- Applied critical thinking and negotiation skills to settle complex claims fairly.
- Effectively managed high volumes of claims by prioritizing tasks and utilizing organizational skills.
- Cultivated strong relationships with external partners to expedite claim resolution processes.
- Communicated clearly and empathetically to enhance customer satisfaction regarding claim outcomes.
Education
Bachelor of Science - Health Information Management
CUNY School of Professional Studies
New York, NY06.2026
Medical Assistant
Wood Tobé-Coburn School
NY06.2009
Skills
- Claims evaluation and investigation techniques
- Policy interpretation with auditing skills
- Implementation of operational procedures
- Organizational planning capabilities
- Team leadership and motivation
- Proficient in Microsoft Office Suite
- Efficient claims processing
- Legal compliance with risk management
- Performance monitoring strategies
- Managing customer expectations effectively
- Training personnel for success
- Expertise in disability claims handling
- Call center transaction management
- Thorough knowledge of insurance policies
- Effective teamwork and collaboration skills
- Exceptional customer service delivery
- Strong problem-solving with critical thinking
- MS office
Languages
Spanish
Native or Bilingual
Timeline
Claims Manager
Bellevue Hospital Center
06.2019 - Current
Assistant Claims Manager
Bellevue Hospital Center
07.2014 - 06.2019
Claims Specialist
Metropolitan Hospital Center
01.2012 - 07.2014
Bachelor of Science - Health Information Management
CUNY School of Professional Studies
Medical Assistant
Wood Tobé-Coburn School
Similar Profiles
Edelia AbenesEdelia Abenes
Labor and Delivery Registered Nurse at Bellevue Hospital CenterLabor and Delivery Registered Nurse at Bellevue Hospital Center
Michelle Pardillo GoboyMichelle Pardillo Goboy
ORAL MAXILLOFACIAL STAFF REGISTERED NURSE at Bellevue Hospital CenterORAL MAXILLOFACIAL STAFF REGISTERED NURSE at Bellevue Hospital Center
Shaphane SinclairShaphane Sinclair
Clinical Nursing Student at Bellevue Hospital CenterClinical Nursing Student at Bellevue Hospital Center
Kenneth EdlamKenneth Edlam
Co-Manager at Seafood MixerCo-Manager at Seafood Mixer
Luis MorenoLuis Moreno
Doorman / Porter at Douglass EllimanDoorman / Porter at Douglass Elliman