Linda Manu
Midlothian,Texas
Summary
Detail-oriented Medical dispute resolution analysis with over 5 years of combined experience in insurance claims, benefits processing, and customer support. Skilled in evaluating medical claims, ensuring compliance with policy and regulatory standards, and resolving disputes with accuracy and empathy. Adept at policy interpretation, data entry, and cross-departmental collaboration to deliver efficient claim resolutions. Strong background in healthcare enrollment, benefits eligibility verification, and patient-centered communication. And patient satisfaction.
Overview
5
5
years of professional experience
Work History
Claim processor & Customer service
United healthcare
10.2024 - Current
- Processed high-volume healthcare claims accurately, ensuring compliance with CMS and HIPAA regulations.
- Verified member eligibility, benefits coverage, and policy terms before claim approval.
- Supported claims adjusters by compiling medical documentation and coding information for claims analysis.
- Coordinated with internal departments to resolve discrepancies and streamline claim workflows.
- Review, evaluate, and process medical and property claims to determine coverage and liability.
- Negotiate settlements with policyholders and providers while ensuring compliance with state and federal regulations.
Claims Data Entry Specialist
Molina Healthcare
01.2021 - 10.2024
- Enter and process a high volume of medical and pharmacy claims quickly and accurately.
- Review, verify, and correct claim forms, ensuring compliance with healthcare and CMS guidelines.
- Identify discrepancies and escalate complex claim issues.
- Maintain strict confidentiality of Protected Health Information (PHI) in compliance with HIPAA regulations.
- Collaborate with claims examiners and supervisors to meet production and quality.
Customer Service Representative (Contract)
Alacrity Solutions Inc
07.2021 - 02.2023
- Educated customers on insurance estimates and procedures, enhancing their understanding and satisfaction, leading to a 15% increase in positive feedback within 3 months.
- Ensured strict adherence to corporate regulations, policies, and procedures, fostering a culture of safety, security, and trust across the organization and its workforce.
- Minimized delays for customers by expertly filling out and processing required insurance forms.
- Enhanced service delivery by implementing a feedback loop within 3 months, resulting in a 20% reduction in customer complaints through accurate record-keeping.
- Determine the least costly path for settling claims by comparing repair costs against expected salvage values.
- Organized files and records and handled other support tasks, and listened to customer requests and specifications and made suggestions to appropriately fulfill needs.
Education
Licensed Vocational Nurse - undefined
Hosanna College of Health Florida
Licensed Adjuster - undefined
High School Diploma - undefined
Skills
Claims processing
Timeline
Claim processor & Customer service
United healthcare
10.2024 - Current
Customer Service Representative (Contract)
Alacrity Solutions Inc
07.2021 - 02.2023
Claims Data Entry Specialist
Molina Healthcare
01.2021 - 10.2024
Licensed Vocational Nurse - undefined
Hosanna College of Health Florida