Hi, I’m
Melissa Caberto
Chicago,IL
Summary
Analytical and results-driven Claims Analyst with proven success in rework reduction, claims processing, and appeals resolution. Experienced in researching complex issues, identifying trends, and supporting operational improvements across multiple systems. Skilled in Excel, data analysis, contract evaluation, and cross-functional collaboration. Highly adaptable and quick to learn new platforms, with a strong work ethic and passion for process improvement.
Overview
7
years of professional experience
Work History
Optum
Claims Adjuster
11.2022 - Current
Job overview
- Lead financial review and resolution of denied claims, identifying root causes and supporting rework initiatives.
- Analyze large data sets to ensure accuracy of contract terms, provider reimbursement, and member eligibility.
- Track and report denial trends, offering recommendations to leadership for claim quality improvements.
- Maintain accuracy and productivity while meeting strict turnaround times.
- Examine claims forms and other records to determine insurance coverage.
- Quickly adapt to evolving tools and systems, demonstrating a strong ability to learn independently.
Centene Corporation
Claims Analyst
08.2021 - 11.2022
Job overview
- Resolved complex and high-dollar claim appeals, reducing rework through detailed research and communication.
- Created reports to uncover denial patterns, supporting data-driven decision-making.
- Collaborated with internal teams to improve claims accuracy and minimize repetitive rework.
- Ensured financial compliance and supported audit readiness.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
Duly Health and Care
Coding Clerk
09.2019 - 08.2021
Job overview
- Supported the claims team by coding and documenting patient encounters for billing and appeal purposes.
- Communicated with providers to resolve discrepancies and improve claim accuracy.
- Streamlined the coding process with effective use of electronic health record systems, optimizing productivity.
Duly Health and Care
Central Scheduler
12.2017 - 09.2019
Job overview
- Assisted patients with claim-related inquiries and coordinated with departments to resolve grievances.
- Managed appointment scheduling via EPIC and supported front-end revenue cycle tasks.
Education
Joliet Junior CollegeJoliet, IL
Associate’s Degree from Applied Science - Registered Health Information Management
Skills
- Claims Rework & Appeals Resolution – Extensive experience correcting denials and supporting rework initiatives
- Data & Financial Analysis – Strong Excel skills; analyze claims data to detect patterns and discrepancies
- Process Improvement – Identify and resolve workflow issues to reduce errors and rework
- Contract & Regulatory Compliance – Familiar with HIPAA, CMS guidelines, and provider agreements
- Collaboration & Communication – Clear communicator with cross-functional teams and external stakeholders
- Quick Learner – Eager to learn new systems like COSMOS and continuously expand knowledge base
Timeline
Claims Adjuster
Optum
11.2022 - Current
Claims Analyst
Centene Corporation
08.2021 - 11.2022
Coding Clerk
Duly Health and Care
09.2019 - 08.2021
Central Scheduler
Duly Health and Care
12.2017 - 09.2019
Joliet Junior College
Associate’s Degree from Applied Science - Registered Health Information Management
Similar Profiles
Nowelle HoweNowelle Howe
Quality Specialist at OptumQuality Specialist at Optum
Rushik Reddy GangamRushik Reddy Gangam
Software Engineer - Remote at OptumSoftware Engineer - Remote at Optum
Arun ChoudharyArun Choudhary
Quality Analyst at OptumQuality Analyst at Optum
Adam DugginsAdam Duggins
Associate Director, Workforce Planning at OptumAssociate Director, Workforce Planning at Optum
Bhavya Sri PendyalaBhavya Sri Pendyala
FSQ Specialist at Flying Food GroupFSQ Specialist at Flying Food Group