Melissa Laflamme
Manchester
Summary
Flexible hard worker ready to learn and contribute to team success.
Experienced Claims Representative with background in insurance, healthcare, and customer service. Strengths include strong analytical skills, ability to handle multiple tasks efficiently, and exceptional communication abilities. Previous work has involved investigating insurance claims, negotiating settlements, and providing superior service to policyholders. Have consistently improved efficiency and reduced claim processing timeframes in past roles.
Overview
11
11
years of professional experience
2006
2006
years of post-secondary education
1
1
Certification
Work History
Patient Access Representative
Solution health
Manchester
12.2020 - 11.2025
- Managed patient registrations and verified insurance information efficiently.
- Scheduled appointments and coordinated patient flow within the facility.
- Communicated with patients to gather necessary documentation and information.
- Evaluated claims for accuracy and compliance with company policies.
- Communicated with clients to gather necessary documentation for claims processing.
- Collaborated with team members to streamline claims processing workflows.
- Assisted clients in understanding their coverage and claim status updates.
- Maintained detailed records of all communication with customers, claimants, providers, and internal departments.
- Filed appeals on behalf of customers when necessary after denial of a claim due to insufficient evidence.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
- Processed medical claims for various health insurance providers efficiently.
- Reviewed and analyzed claim submissions for accuracy and completeness.
- Communicated with healthcare providers to resolve claim discrepancies effectively.
- Verified patient eligibility and benefits information using established systems.
- Reviewed denials, rejections, and underpayments from insurance carriers.
- Submitted and tracked medical claims to insurance companies via electronic or paper methods.
- Resolved issues related to denied or underpaid claims in a timely manner.
- Verified patient eligibility for medical claims and determined benefit coverage.
- Processed appeals on rejected or partially paid claims, including filing additional paperwork as needed.
- Adhered to HIPAA regulations while managing confidential patient information.
- Assisted with the development of new billing procedures and policies.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Examined claims, records and procedures to grant approval of coverage.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
Medical Representative
Balanced Healthcare Receivables LLC
Nashua
12.2017 - 12.2020
- Managed inbound and outbound calls to ensure customer satisfaction.
- Documented customer interactions in the database for future reference.
- Assisted customers with inquiries, providing clear and accurate information.
- Trained new staff on call handling procedures and company policies.
- Utilized CRM software to track customer interactions and follow-ups.
- Answered incoming calls and provided accurate information to customers.
- Reviewed documentation for accuracy and completeness before approval.
Inbound Call Center Representative
Callogix
Bedford
12.2014 - 12.2017
- Handled inbound customer inquiries with professionalism and efficiency.
- Provided accurate information about products and services to customers.
- Resolved customer issues by following established protocols and procedures.
- Assisted providers with benefit inquiries and claims processing.
- Assisted members with account inquiries and service requests.
- Assisted clients with Medicare enrollment processes and eligibility verification.
- Educated beneficiaries on plan options and covered services.
- Processed enrollment applications using internal management systems efficiently.
Education
Medical Coding - Medical Coding Certificate
Manchester Community College
Manchester, NH 12.2011 - 12.2012
Manchester West High School
Manchester, NhSkills
- Patient registration
- Insurance verification
- Claims processing
- Medical billing
- HIPAA compliance
- Claims analysis
- Documentation review
- Attention to detail
- Organizational skills
- Task prioritization
- Epic training
- Compliance adherence
- Electronic claims submission
- Benefit coordination
- CMS guidelines
- Medicare regulations
- ICD-10
- Claims processing proficiency
- Billing software
- Insurance plan verification
- Patient contact
- Claims adjustment
- Insurance software
- Medical coding
- Claim submission
- Eligibility verification
- ICD-10 knowledge
- CPT coding
- Eligibility determination
- Data entry software
- Insurance terminology
- Claims preparation
- Electronic authorization processing
- Skilled in epic
- Skilled in nthrive
- Skilled in connexs
- Healthcare regulations
- Medical terminology
- Claims documentation
- Claims investigation
Certification
- Certified Revenue Cycle Representative (CRCR) 2025
References
References available upon request.
Timeline
Patient Access Representative
Solution health
12.2020 - 11.2025
Medical Representative
Balanced Healthcare Receivables LLC
12.2017 - 12.2020
Inbound Call Center Representative
Callogix
12.2014 - 12.2017
Medical Coding - Medical Coding Certificate
Manchester Community College
12.2011 - 12.2012
Manchester West High School