Ashley Iose
Anaheim,CA
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Claims Examiner
Molina Healthcare
Long Beach, CA
2018 - Current
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- 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.
- Utilized 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.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Researched claims and incident information to deliver solutions and resolve problems.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
Provider Services Representative
Molina Healthcare
Long Beach, CA
08.2015 - 10.2017
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Acted as a liaison between providers and company leadership, effectively communicating concerns and feedback to facilitate continuous improvement initiatives.
- Evaluated provider contracts for accuracy and completeness before submission to final approval process.
Member Service Representative
Molina Healthcare
Long Beach, CA
10.2013 - 08.2015
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
- Built rapport with members by engaging in genuine conversations and demonstrating a commitment to their financial wellbeing.
- Handled complaints with prompt, courteous service to uphold professional reputation.
- Assisted members with account management, including updating personal information and setting up automated payments.
- Verified customer identification and documentation for compliant transactions.
- Promoted a positive work environment by fostering open communication between colleagues and supervisors.
- Consistently met or exceeded performance metrics through proactive management of workload and effective prioritization.
Education
Redondo Union High School
Redondo Beach, CA06.2010
Skills
- Claims processing
- Verbal communication
- Data verification
- Disability claims process
- Coding systems
- Healthcare procedures
- Claims evaluation
- Payment processing
- Qnxt
- Salesforce
- Claims adjustment
Certification
PCA - Patient Care Assistant for Long Beach Memorial
HIPAA & FWA - Training course through Molina Healthcare & certified
Languages
Samoan
Native or Bilingual
Timeline
Provider Services Representative
Molina Healthcare
08.2015 - 10.2017
Member Service Representative
Molina Healthcare
10.2013 - 08.2015
Claims Examiner
Molina Healthcare
2018 - Current
Redondo Union High School