Ramona Matthews
Tampa,FL
Summary
Experienced Claims Administrator with expertise in claims management and processing. Proficient in record maintenance, negotiation of claim settlements, and delivering customer service under pressure. Track record of implementing strategies that enhance productivity and efficiency in claims resolution. Strong communication skills with stakeholders across all levels. Experienced in health insurance claims adjudication with in-depth knowledge of billing codes and regulatory standards. Possess strong decision-making skills, aimed at resolving complex claim issues while maintaining cost controls. Noted for improving efficiency in processing claims by implementing innovative solutions. Strengths include analytical abilities, attention to compliance details, and effective communication skills.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claims Administrator
Wipro Technologies
Tampa, FL
09.2021 - Current
- Researched and analyzed claim information to determine validity of coverage.
- Reviewed and processed insurance claims for accuracy and completeness.
- Conducted audits of existing policies to ensure proper coding and billing practices were followed.
- Adhered to all applicable laws, regulations, and company standards while processing claims.
- Applied knowledge of coding systems such as CPT-4 and HCPCS codes for proper reimbursement.
- Participated in meetings with internal stakeholders regarding changes in policy, procedure, technology.
Health Insurance Coordinator
BCBS of Florida
Tampa, FL
03.2019 - 08.2021
- Evaluated customer feedback on products and services offered by the company in order to identify areas of improvement.
- Adhered to all applicable laws, regulations, and company standards while processing claims.
- Collaborated with internal teams such as marketing, finance and operations departments in order to ensure successful execution of projects from start to finish.
- Performed data entry from paper documents, emails, and other sources into computer systems.
Health Insurance Advocate
Cognizant Technologies
Tampa
01.2014 - 03.2019
- Collaborated with internal departments such as IT, finance, legal, marketing, to resolve any issues concerning health plans.
- Reviewed and analyzed health care claims to identify discrepancies, errors or frauds.
- Provided accurate information about products and services to customers.
- Developed strong relationships with customers by providing personalized assistance and support.
- Answered customer inquiries via phone, email, and chat.
Education
High School Diploma -
D.W Waters Career Center
Tampa, FL05-2006
Skills
- Claims processing
- Data analysis
- Regulatory compliance
- CPT-4 coding
- HCPCS coding
- Policy auditing
- Project management
- Medical terminology knowledge
- Contract Review
- Claims Adjucation
Certification
Health Insurance Sales Iicense
Timeline
Claims Administrator
Wipro Technologies
09.2021 - Current
Health Insurance Coordinator
BCBS of Florida
03.2019 - 08.2021
Health Insurance Advocate
Cognizant Technologies
01.2014 - 03.2019
High School Diploma -
D.W Waters Career Center
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