Sina Sauvao
Lakewood, Washington
Summary
Detail-oriented claims processor with a strong focus on regulatory compliance and data verification. Proven ability to maintain performance metrics while ensuring confidentiality and accuracy in a virtual environment.
Overview
3
3
years of professional experience
Work History
Healthcare insurance processor
CVC health Aetna
Arizona
02.2024 - 02.2025
- Process incoming Medicaid claims in accordance with established policies, procedures, and regulatory guidelines.
- Verify required data fields for accuracy and completeness, ensuring all necessary medical records are received and reviewed when applicable.
- Direct claims for medical review when necessary to guarantee accurate adjudication and compliance.
- Maintain balanced performance metrics across productivity, accuracy, and quality standards.
- Uphold strict confidentiality standards and comply with HIPAA regulations.
- Work effectively in a virtual, work-from-home environment while meeting daily production goals and collaborating with team members.
Provider Claim Resolution Specialist
HealthCare Service Corporation, HCSC, BlueCard Central
Illinois City
03.2022 - 01.2023
- Communicated effectively with providers to clarify claim statuses and requirements.
- Reviewed claim submissions for accuracy and completeness before processing payments.
- Utilized claims management systems to track and process provider inquiries efficiently.
- Collaborated with cross-functional teams to address claim discrepancies and issues.
- Resolved provider claims by analyzing documentation and eligibility criteria.
Education
Associate of Science -
American Samoa Community College
Pago Pago 08-2018
High School Diploma -
Tafuna High School
Pago Pago 06-2014
Skills
- Claims processing
- Data verification
- Regulatory compliance
- Claims management systems
- Medical review coordination
- Provider communication
- Work-from-home expertise
- Virtual teamwork
- Confidentiality adherence
- Time management
- Claim processing
- Great mathematical skills
- Problem resolution
- Attention to detail
Timeline
Healthcare insurance processor
CVC health Aetna
02.2024 - 02.2025
Provider Claim Resolution Specialist
HealthCare Service Corporation, HCSC, BlueCard Central
03.2022 - 01.2023
Associate of Science -
American Samoa Community College
High School Diploma -
Tafuna High School