Marisol De Luna
Austin
Summary
Dynamic Claims Liaison at USA Managed Care Organization with expertise in claims analysis and customer service. Proven track record in identifying cost-saving opportunities and resolving disputes efficiently. Skilled in medical billing and data entry, while maintaining confidentiality and fostering team collaboration to enhance departmental efficiency. I am interested in joining your company, and I believe that this position offers the growth potential to utilize my skills and knowledge gained from my previous employers.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claims Liasion
USA Managed Care Organization
Austin
03.2017 - 08.2021
- Analyzed claim data to identify areas of concern or potential cost-saving opportunities for clients.
- Maintained accurate records of all communications related to each claim case being handled by the department.
- Provided timely feedback on claim status updates to clients and other stakeholders.
- Conducted research into specific cases, including gathering additional information as needed from clients and other parties involved in a claim.
- Escalated unresolved complaints or disputes to higher level staff members for further review.
- Actively participated in team meetings aimed at improving overall efficiency within the department.
- Reviewed medical bills for accuracy prior to submitting them for payment consideration.
- Resolved customer disputes regarding claims processing in a professional manner.
- Analyzed contracts and claim systems to apply appropriate benefit amounts.
- Maintained confidentiality of policyholder information in compliance with HIPAA regulations.
- Managed workload to meet or exceed productivity and quality standards.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Analysis of complex claims for repricing.
- Identifying discrepancies in payments, as well as payment updates.
- Process claims in accordance with proper policies and regulations.
- Demonstrate a strong knowledge of all relevant products.
- Strong computer skills.
- Data entry.
Receptionist
West Texas Insurance Exchange
11.2014 - 05.2016
- Responsible for greeting visitors and determining their nature of business.
- Answered and direct all multi-line incoming calls.
- Performed other duties as directed by department, responsible for payments.
- Open, read, sort, distribute incoming mail, and prepare outgoing packages scheduled for deliver.
- Ordered supplies
Head Collector (assistant manager)
Drug Screen Compliance
06.2010 - 02.2014
- Supervised instructed and assists employees at a collection site, received and made an initial inspection of the specimen provided by those employees who initiated and completed the federal drug testing control form.
- Ordered inventory, answered phone calls, training of new employees, assigned tasks, shipping/receiving, Maintained vehicle logs, and vehicles cleaned.
- Random Department Assistant: Data entry, and assisted our consortium members with questions and concerns.
- Courier
Customer Service
Burkes
03.2010 - 06.2010
- Cash Accountability
- Stocking
Education
High School Diploma -
Kermit High School
Kermit, TX05.2006
Associate of Applied Science - Applied science
Odessa College
Odessa, TXSkills
- Formfox- Online Drug and Alcohol Test Collections
- Escreen Drug Screening Technology
- Drugpak- Drug Testing Software
- Act! Premium Contact & Customer Manager
- 10 Key
- 68 wpm
- Customer service
- Medical billing
- Data entry
- Confidentiality management
- Workload management
- Team collaboration
- Fluent with Microsoft office
- Claims analysis
Certification
- H2s Certified, 2013
- Mask Fit, 2013
- Lifeloc EV30 Calibration, 2011
- Designative Employee Representative, 2012
- Breath Alcohol Technician Proficient in 49 CFR part 40 Procedures, 2011
- Hair Testing Technician, 2010
- D.O.T (Department Of Transportation) Collector Proficient in 49 CFR Part DOT Collections Procedures, 2010
Personal Traits
- Bilingual
- Highly Organized
- Punctual
- Positive Work Ethic
- Willingness to take instruction
- Managerial
Languages
English
Professional
Spanish
Professional
Timeline
Claims Liasion
USA Managed Care Organization
03.2017 - 08.2021
Receptionist
West Texas Insurance Exchange
11.2014 - 05.2016
Head Collector (assistant manager)
Drug Screen Compliance
06.2010 - 02.2014
Customer Service
Burkes
03.2010 - 06.2010
High School Diploma -
Kermit High School
Associate of Applied Science - Applied science
Odessa College
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