Veronika Hopkins
Chandler,AZ
Summary
Experienced Medical Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering over 25 years of experience and willingness to take on any challenge. As well as the ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
26
26
years of professional experience
Work History
Senior Claim Benefit Specialist
Aetna/CVS
04.1997 - Current
- Reviews and adjudicates routine claims in accordance with claim processing guidelines
- In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic correspondence Handling System - system used to process correspondence that is scanned in the system by a vendor)
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Applies medical necessity guidelines, determines coverage, complete eligibly verification, identify discrepancies and applies all cost containment measures to assist in the claim adjudication process
- Communicated effectively with staff members of operations, finance and clinical departments.
- Proofs claim or referral submission to determine, review or apply appropriate guidelines, coding, member identification process, diagnosis and pre-coding requirements
Education
Bachelor of Science - Information Technology
Western International University
Tempe, AZ06.2007
Skills
- Federal Guidelines
- Claim Processing
- Claims Review
- Determine Medical Necessity
- Claims Preparation
- Insurance Industry Experience
Timeline
Senior Claim Benefit Specialist
Aetna/CVS
04.1997 - Current
Bachelor of Science - Information Technology
Western International University
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