Magdalena Ortiz
El Paso,TX
Summary
Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards. Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate online systems. Effective at operating within company regulations and strict department guidelines to manage telephone calls, emails, letters and in-person requests for assistance. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
1
1
year of professional experience
Work History
Claims Representative
Blue Cross Blue Shield Of Texas
08.2022 - Current
- Analyzed and addressed escalated claims to resolve issues quickly.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Followed up with customers on unresolved issues.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Maintained accurate and up-to-date records of claim information for future reference.
- Interviewed policyholders to verify information and obtain additional details.
- Developed and implemented strategies to improve claim processes.
- Monitored and managed claim expenses to control costs and maximize profitability.
- Generated, posted and attached information to claim files.
- Checked documentation for accuracy and validity on updated systems.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Modified, updated and processed existing policies.
- Determined appropriateness of payers to protect organization and minimize risk.
Education
No Degree - Medical Insurance Coding
DeVry University
Downers Grove, IL03.2024
Skills
- Policy Understanding
- Settlement Negotiation
- Insurance Claims Review
- Policy Knowledge
- Time Management
- File Management
- Conflict Resolution
- Telephone Etiquette
- Professionalism
- Stress Management
- Microsoft Office
- Adaptability
- Critical Thinking
- Product Knowledge
- Insurance Regulations
- Active Listening
- Organizational Skills
- Eligibility Determination
- Data Entry
- Policy Review
- Denied Claims Identification
- Patient Contact
Timeline
Claims Representative
Blue Cross Blue Shield Of Texas
08.2022 - Current
No Degree - Medical Insurance Coding
DeVry University