Summary
Overview
Work History
Education
Skills
Timeline
Generic

Melissa Chapa

Helotes,TX

Summary

At Aetna, I spearheaded initiatives that enhanced claims processing efficiency and compliance, leveraging my expertise in claims analysis and exceptional customer service skills. My strategic approach to claim investigation and dedication to confidentiality significantly improved client satisfaction and operational effectiveness, achieving a notable reduction in claim resolution times.

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.

Claims specialist with results-driven mindset and focus on efficient claims processing and resolution. Skilled in analyzing complex claims, verifying coverage, and negotiating settlements, with strong emphasis on team collaboration and adapting to changing needs. Known for reliability, attention to detail, and delivering consistent outcomes in high-pressure environments.

Qualified Desired Position with solid background in claims benefit management. Successfully handled numerous claims, ensuring timely and accurate processing. Demonstrated strong analytical skills and effective communication to resolve complex issues.

Professional claims specialist with robust experience in benefit administration. Proven track record of efficiently managing claims processes and resolving disputes. Valued for team collaboration and adaptability while maintaining strong focus on achieving results. Skilled in data analysis and customer service, consistently reliable under pressure.

Experienced with claims benefit evaluation, delivering precise and timely claims processing. Utilizes analytical skills and problem-solving to manage claims effectively. Track record of strong communication and collaboration, ensuring efficient workflow and client satisfaction.

Experienced Type Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering Number years of experience and willingness to take on any challenge.

Pragmatic Insurance Verification Specialist touting Number years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail.

Innovative technology professional with several years of diverse experience. Skilled in enhancing systems and aligning technical solutions with business objectives. Proven success in leading projects from start to finish and contributing to organizational growth and success.

Results-oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance.

Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Job Title position. Ready to help team achieve company goals.

Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.

Overview

10
10
years of professional experience

Work History

Claims Benefit Specialist

Aetna
09.2014 - Current
  • Provided exceptional customer service by addressing client inquiries promptly and professionally.
  • Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
  • Maintained up-to-date knowledge on industry regulations and guidelines, ensuring compliance throughout the claims process.
  • Collaborated with medical professionals to obtain accurate information for proper benefit determination.
  • Negotiated settlements on disputed claims, resulting in equitable resolutions for all parties involved.
  • Maintained a high level of accuracy when inputting data into internal databases, ensuring all information was readily available for review by other team members as needed.
  • Developed training materials and conducted workshops for new employees, increasing their understanding of company policies and procedures.
  • Supported management in identifying areas of potential cost savings through the evaluation and implementation of alternative claim resolution strategies.
  • Reviewed policy coverage details thoroughly before making determinations on benefits eligibility for each unique claim scenario presented.
  • Managed high-volume caseloads, consistently meeting deadlines and maintaining accuracy in claim review.
  • Facilitated communication between departments, ensuring timely resolution of outstanding claims.
  • Contributed to team success by sharing expertise on complex cases and collaborating on strategies to increase efficiency in case management tasks.
  • Built trust between clients and our organization by providing transparent communication along every step of the process from initial inquiry through final settlement payout.
  • Identified trends in claims data to proactively address potential issues affecting benefit payouts or customer satisfaction levels.
  • Handled sensitive claimants'' personal information with discretion, maintaining confidentiality at all times during the claims process.
  • Conducted comprehensive audits to identify areas of improvement within the claims process, leading to a more efficient system.
  • Resolved complex claims issues for improved customer satisfaction and reduced claim backlog.
  • Assisted in the development of department goals and objectives, actively working towards achieving them through individual performance metrics tracking efforts.
  • Decreased turnaround time for claim approvals with thorough investigation and efficient documentation.
  • Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Checked documentation for accuracy and validity on updated systems.
  • Verified client information by analyzing existing evidence on file.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Generated, posted and attached information to claim files.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Coordinated with contracting department to resolve payer issues.
  • Determined appropriateness of payers to protect organization and minimize risk.

Education

High School Diploma -

Harlendale Highschool
San Antonio, TX

Skills

  • Claims analysis
  • Microsoft Office
  • Claim investigation
  • Confidentiality handling
  • Policy Interpretation
  • Claims Investigation
  • Insurance knowledge
  • Teamwork and Collaboration
  • Customer Service
  • Problem-Solving
  • Time Management
  • Attention to Detail
  • Problem-solving abilities
  • Multitasking
  • Organizing and Prioritizing Work
  • Excellent Communication
  • Critical Thinking
  • Organizational Skills
  • Team Collaboration
  • Effective Communication
  • Adaptability and Flexibility
  • Decision-Making
  • Teamwork skills
  • Claims Processing
  • Relationship Building
  • Computer Proficiency
  • Documentation skills
  • Data Entry
  • Task Prioritization
  • Self Motivation
  • Medical Terminology
  • Interpersonal Skills
  • Prior authorization processing
  • Conflict Resolution
  • Professionalism
  • Document Review
  • Documentation abilities
  • Interpersonal Communication
  • Insurance Claim Forms Review
  • Policy Review
  • Coverage Determination
  • Policy Renewals
  • Documentation processing
  • Insurance Coverage Verification
  • Time management abilities
  • Medicaid knowledge
  • Adaptability
  • Written Communication
  • Understanding of medical terms
  • Denied claims identification
  • Eligibility Determination
  • Claim Amount Calculations
  • Skilled in Software
  • Policy Implementation
  • Records Management
  • Professional Demeanor
  • Problem-solving aptitude
  • Patient Rapport
  • Information Verification
  • Premium Calculations

Timeline

Claims Benefit Specialist

Aetna
09.2014 - Current

High School Diploma -

Harlendale Highschool
Melissa Chapa