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Phaulynne
Medical Claims Analyst with 3+ years of claims processing expertise
Contacto
Competencias
Analyzed and adjudicated medical claims, ensuring compliance with policies and timeliness.
Handled receipt, encoding, labeling, and filing of documents to support claims operations.
Ensured accuracy in reviewing claims documents and processing for compliance and correctness.
Facilitated clear communication with medical providers and internal teams for claims adjudication.
Proficient in Microsoft Word and Excel for documentation, reporting, and workflow management.
Educacion
Resumen
Experienced in analyzing, adjudicating, and processing medical claims, ensuring accuracy and adherence to policies. Skilled in document management and workflow optimization with strong attention to detail.
Logros Clave
- Processed claims efficiently adhering to policies, ensuring timely settlements within SLA standards at ICARE.
- Reviewed and adjudicated claims for accuracy, aligning with coverage policies during tenure at GROWVITE STAFFING SERVICES INC.
- Managed document encoding, filing, and tracking, streamlining workflows and improving document handling accuracy.
Experiencia
MEDICAL CLAIMS ANALYST
Responsible for analysing, adjudicating and processing of claims according to set medical guidelines, policies within the agreed (Service Level of Agreements)., Ensures accurate and timely processing of claims from medical service providers within authority limits.
CLAIMS PROCESSOR
Ensures accurate review of claims documents like LOA, hospital bills/SOA original OR for use in processing claims, Reviews/evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards.
CLERK
Receives incoming documents, trackers and forms manually or using MS products, Encodes documents, trackers and forms for reporting purposes, Labels, files and sorted documents in the respective folders/ envelope and boxes forwards it to the appropriate person or department.