Sanjida Akter
Summary
Experienced Claims Processing Specialist with thorough understanding of claims management systems and insurance procedures. Efficient in analyzing claim information, determining coverage, and processing payments while adhering to policy regulations. Strengths include strong analytical skills, problem-solving abilities, and customer service expertise.
Overview
8
8
years of professional experience
Work History
Claims Processing Specialist
Praesum Healthcare Services, LLC
05.2023 - 09.2024
- Audited counselors' notes before proceeding with patient billing.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Verified eligibility, benefits, authorization requirements for services rendered.
- Analyzed patient accounts to identify underpayments or overpayments.
- Applied knowledge of insurance plans, regulations and guidelines in adjudicating claims.
- Investigated, researched and responded to customer inquiries regarding billing issues.
- Performed data entry into various systems related to claims processing tasks.
- Monitored aged claims on a regular basis to ensure timely resolution of disputes.
- Attended training sessions to stay current on new policies or procedures for claim processing.
- Worked collaboratively with other departments such as customer service and coding staff.
- Generated reports summarizing daily activity related to claims processing operations.
- Reviewed submitted documentation from providers for completeness prior to submitting claims.
- Assisted with developing departmental processes that improved overall efficiency.
- Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
- Organized information by using spreadsheets, databases or word processing applications.
Team Lead
Follett Corporation, Palm Beach State College Bookstore
08.2016 - 05.2023
- Key holder of technology supplies
- Processed, shipped, and received store web orders
- Trained new staff in relevant processes and procedures.
- Operated cash registers, managed inventories
- Assisted customers by staying knowledgeable about store products
- Resolved customer complaints and issues promptly, ensuring high levels of satisfaction.
- Kept work areas clean, neat and free of safety hazards to maximize efficiency.
Education
Bachelor of General Studies-Education -
Florida Atlantic University
Boca Raton, FL12.2022
Associate of Arts -
Palm Beach State College
Lake Worth, FL08.2017
Skills
- Microsoft Word
- Excel
- PowerPoint
- Payments posting
- Customer Service
- Eligibility Determination
- Teamwork and Collaboration
- Data Entry
- Billing Software
- Account Management Software
- Invoice Verification
- Performance monitoring
- Allocating claims
- Research abilities
- Claim Amount Calculations
- Problem-Solving
- Understanding of medical terms
Volunteer Experience
- Student Assistant- Lake Worth Community High School
- Lantana Branch Library Book Shelfer
- American Muslim Alliance Of Florida, LLC
Languages
English
Full Professional
Bengali
Native/ Bilingual
Affiliations
- Shape Club Member- Lake Worth Community High School
Timeline
Claims Processing Specialist
Praesum Healthcare Services, LLC
05.2023 - 09.2024
Team Lead
Follett Corporation, Palm Beach State College Bookstore
08.2016 - 05.2023
Bachelor of General Studies-Education -
Florida Atlantic University
Associate of Arts -
Palm Beach State College
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