Tomitra Almanza
Humble,TX
Summary
Service-oriented professional with over 2 years of experience in property claims and leave of absence settings. Skilled in advocating for customers and organizations. Seeking a challenging position to enhance skills and gain rewarding experiences. Proficient in medical terminology with a typing speed of 65+ WPM. Experienced in FOS scanning, HIPAA compliance, Meditech Passport, Microsoft Office, Cerner scheduling, RadNet, Ecapture, Cubis, All Scripts, Onbase, Touch Chart, EMR, ECOS, GE, Availity, XACT analysis, Doc Clerk, ECW, and Xactimate.
Overview
12
12
years of professional experience
Work History
Cat Claims Adjuster
The Hartford
05.2022 - Current
- Review and processed insurance claims for accuracy, completeness, and compliance with company policies and regulations requirements, maintaining a 98% accuracy rate
- Utilize active listening and critical thinking skills to quickly analyze and clearly understand a specific request or customer need, and then leverage knowledge and resources to provide the appropriate solutions
- Act as a liaison with other departments to resolve problems
- Secure essential facts about losses
- Negotiates settlements
- Interprets, understands, and explains coverage to policyholders
- Efficiently updates and moves files to closure
- Ability to review, record and organize written data from a variety of sources with no prescribed format is essential.
Care Management Support
Humana
11.2020 - 05.2022
- Obtain demographic, insurance and financial information from patient or guarantor
- Enter information in computer system efficiently
- Assist with scheduling appointments as needed
- Explain all required forms to the patient or guarantor and obtain the required signatures
- Ensure medical necessity compliance by obtaining necessary data and review Compliance system
- Verify insurance eligibility, benefit details and authorizations
- Listens to customers' requests and inquiries
- Works to retain policyholders who inquire about canceling auto policies through open listening, negotiating, and policy review of customer issues
- Uses de-escalation tactics and when necessary, escalates to appropriate team.
Patient Access Registrar/Admitting Representative
HCA/Parallon
10.2018 - 11.2020
- Receive and greet patients, caregivers, and families in a professional and caring manner
- Gather and update information regarding demographics and insurance in a respectful and confidential fashion
- Schedule and confirm appointments including providing prep and any additional pertinent information
- Insurance verification and obtain pre-certification or authorization as needed
- Collect co-pays and deductibles from financial responsible parties
- Monitor waiting rooms and keep patients/families informed to any schedule delays
- Assist with bed control and management as needed.
Patient Access Representative
UT Physicians
02.2016 - 10.2018
- Obtain demographic, insurance and financial information from patient or guarantor
- Enters information in computer system efficiently
- Assist with scheduling appointments as needed
- Explain all required forms to the patient or guarantor and obtain the required signatures
- Ensure medical necessity compliance by obtaining necessary data and review Compliance system
- Verify insurance eligibility, benefit details and authorizations.
Patient Access Representative II
Memorial Hermann Healthcare Systems
01.2013 - 02.2016
- Schedule outpatient radiology appointments in a high call volume call center
- Obtain demographic, insurance and financial information from patient or guarantor
- Monitor, review, and resolve patient account issues
- Route calls to the appropriate departments as needed
- Communicate in an effective and professional manner with Physicians, ancillary departments, physician’s office staff, insurance companies, as well as patients and their families.
Education
Associate Degree in Business Management/Human Resource -
Houston Community College
Houston, TX12.2024
Skills
Claims Investigation
Highly motivated
Claims Processing
Advanced oral and written communication skills
Risk Assessment
Insurance policy coverage knowledge
Caseload Management
Policy Interpretation
Casualty and property loss
Regulatory Compliance
Quality Control
Policy investigations
Damage Assessment
Advanced computer skills
State Name Claims Adjuster License
Data Analysis
Legal Compliance
Critical Thinking
Customer service and support
Computer Skills
Active Listening
Team Collaboration
Claims adjustment
Decision-Making
Settlement Negotiation
Claims
Claims Evaluation
Relationship Building
Coverage Determination
Property Damage Assessment
MS Office
Settlement Negotiations
Microsoft Office Suite
Payment Processing
Timeline
Cat Claims Adjuster
The Hartford
05.2022 - Current
Care Management Support
Humana
11.2020 - 05.2022
Patient Access Registrar/Admitting Representative
HCA/Parallon
10.2018 - 11.2020
Patient Access Representative
UT Physicians
02.2016 - 10.2018
Patient Access Representative II
Memorial Hermann Healthcare Systems
01.2013 - 02.2016
Associate Degree in Business Management/Human Resource -
Houston Community College