Monica Romo
Las Vegas,NV
Summary
Active Claims Examiner at Zenith-American Solutions with experience in medical claims processing and coordination of benefits. Ability to enhance customer satisfaction through effective communication and meticulous data verification. Ensuring confidentiality while efficiently evaluating claims, contributing to operations and improved client trust. Objectively interested in a long-term position where I can utilize my skills and experienced knowledge for the growth of both the employer and myself.
Overview
14
14
years of professional experience
Work History
Claims Examiner, Coordination of Benefits
Zenith-American Solutions -Culinary
07.2019 - Current
- Handling sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilizing analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Maintaining the process of Coordinating Benefits along with Other Outside Insurance Verifications.
- Maintaining detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
QMCSO, Enrollments and Eligibility Clerk
Zenith-American Solutions -Culinary
05.2013 - 07.2019
- Contributed to policy development discussions, helping create guidelines that ensured fair treatment of all applicants while maintaining compliance with government regulations.
- Implemented feedback from supervisors and peers, continuously improving work processes and contributing to team success.
- Developed a system for tracking application progress, resulting in greater transparency for both staff members and clients.
- Boosted customer satisfaction rates, addressing client concerns promptly and providing accurate information about their eligibility status.
- Reviewed case files periodically to ensure compliance with changing regulations and to identify any necessary adjustments.
- Established positive relationships with community organizations that referred clients seeking assistance with determining their eligibility.
- Assisted with Employer Reports, organizing and checking entries.
- Assisted with Employee Work Hours Reports and Calculations.
Customer Service Representative
ABPA American Benefit Plan Administrator -Culinary
01.2012 - 05.2013
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Providing Members/Participants and Providers alike with Benefits, Eligibility and Claims or Appeals information.
- Resolved Member/Participants complaints with empathy, resulting in increased loyalty and repeat business.
- Handled Provider calls efficiently, finding satisfactory resolutions for both patients and providers.
- Enhanced Participant satisfaction by promptly addressing concerns and providing accurate information.
- Addressed customer inquiries to ensure satisfaction and foster positive service experience.
Pension Clerical Support
ABPA American Benefit Plan Administrator -Culinary
11.2010 - 01.2012
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Handled Retiree Calls while working the Pension Counter supporting and assisting Pensioners.
Education
High School Diploma -
City of Angels
Los Angeles, CASkills
- Medical Claims Processing
- Coordination of Benefits and Other Outside Insurance Verification Experience
- Disability Claims Processing
- Experienced QMCSO Processing
- Culinary Eligibility and Enrollment Experience
- Culinary Contribution Accounting Clerical Support
- Culinary Customer Service Experience
- Culinary Pension Clerical and Retiree Support
Timeline
Claims Examiner, Coordination of Benefits
Zenith-American Solutions -Culinary
07.2019 - Current
QMCSO, Enrollments and Eligibility Clerk
Zenith-American Solutions -Culinary
05.2013 - 07.2019
Customer Service Representative
ABPA American Benefit Plan Administrator -Culinary
01.2012 - 05.2013
Pension Clerical Support
ABPA American Benefit Plan Administrator -Culinary
11.2010 - 01.2012
High School Diploma -
City of Angels
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