Summary
Work History
Education
Skills
Timeline
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Michaela Salmeri

Rotterdam,NY

Summary

Professional Recovery Associate with expertise in loss mitigation and coordination of benefits at MVP Healthcare. Proficient in Microsoft Excel and skilled in fostering positive customer relationships, and ensuring compliance with regulations while driving performance improvements.

Work History

Recovery Associate

MVP Healthcare
02.2025 - Current
  • Review medical claims to identify overpayments, duplicate payments, coordination of benefits issues, and other recovery opportunities.
  • Coordinate with third party vendors to track outstanding balances, resolve overpayment situations, and collect refunds. Pay the vendors commissions for their findings.
  • Partner with internal departments such as claims, special investigations unit, and networking to identify root causes of overpayments.
  • Prepare reports on recovery activities, outstanding balances, and performance metrics.
  • Handle provider inquiries to recovery activities in a professional manner.
  • Process any checks owed by MVP out to providers in a timely manner.

Coordination of Benefits Associate

MVP Healthcare
01.2023 - 02.2024
  • Investigate member eligibility and coverage with primary, secondary, or tertiary insurance carriers.
  • Apply COB rules and regulations to determine correct payment responsibility.
  • Analyzed accident related claims to determine no fault or workers compensation involvement and responsibilities.
  • Coordinated with members and external carriers to resolve complex COB issues involving auto accidents and workplace injuries.
  • Review and update member records to reflect COB status.
  • Communicate with members, providers, and insurers to gather and verify correct COB information.
  • Ensure accurate adjudication of claims.
  • Ensure compliance with CMS, state, and federal regulations governing coordination of benefits.

Claims Examiner

MVP Healthcare
07.2021 - 01.2023
  • Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
  • Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
  • Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
  • Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
  • Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.

Customer Service Representative

Emblem Health
09.2019 - 07.2021
  • Handled a high volume of inbound calls and emails.
  • Skilled in written and verbal communication.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.
  • Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.

Customer Service Representative

BlueShield of Northeastern New York
10.2018 - 09.2019
  • Handled a high volume of inbound calls and emails.
  • Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
  • Participated in training programs to enhance product knowledge and customer service skills.
  • Addressed customer inquiries to ensure satisfaction and foster positive service experience.
  • Maintained detailed records of customer interactions and transactions, ensuring accurate documentation and follow-up.

Education

High School Diploma -

Scotia Glenville High School
Glenville
09.2011 - 01.2015

Business Administration And Management

Hudson Valley Community College
Troy, NY
02.2017 - 05.2018

Skills

  • Dispute resolution
  • Clerical / data entry
  • Loss mitigation / asset recovery
  • Customer service
  • Microsoft Excel
  • Facets Software

Timeline

Recovery Associate

MVP Healthcare
02.2025 - Current

Coordination of Benefits Associate

MVP Healthcare
01.2023 - 02.2024

Claims Examiner

MVP Healthcare
07.2021 - 01.2023

Customer Service Representative

Emblem Health
09.2019 - 07.2021

Customer Service Representative

BlueShield of Northeastern New York
10.2018 - 09.2019

Business Administration And Management

Hudson Valley Community College
02.2017 - 05.2018

High School Diploma -

Scotia Glenville High School
09.2011 - 01.2015

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Michaela Salmeri