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Customer Service Data Entry

Location:
Sylmar, California, United States
Salary:
18.00
Posted:
April 29, 2019

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Resume:

Yvette Galaviz

***** ********** **, ******, ** **342

818-***-**** ac88vc@r.postjobfree.com

PROFESSIONAL SUMMARY

Hardworking customer service professional knowledgeable about insurance claims

processes. Seeking a permanent role with room for advancement.

SKILLS

• Excellent sense of direction • Time management

• MS Office • Medical terms and procedure knowledge

• Excellent time management • Health insurance industry knowledge

• Fast learner • Customer service-oriented

• Personable • Organized

• Computer-savvy • Medicare and Medicaid process

WORK HISTORY

CLAIMS EXAMINER 2 01/2009 to 09/2018

United Health Care/March Vision Care - Los Angeles, CA

• Processed complex claims that had been accepted for payment.

• Request and follow up on additional information as needed for incomplete claims.

• Answered calls, emails, and addressing customer inquiries, solving problems.

• Verified patient's accounts for eligibility and benefits.

• Read, interpret and summarize medical contracts/division of responsibility before

allowance of payment.

• Identified claims that were not our financial risk and forwarded to appropriate entity for

payment.

• Reviewed claims that were pending and followed through for payment in a timely manner.

• Worked with various fee schedules.

• Maintained a learned knowledge of benefits claim processing, claims principles, medical

terminology and procedures and HIPAA regulations.

• Utilized administrative guidelines as a resource or to answer questions when processing

claims.

• 100% audit on claims and other examiners.

• Calculated other insurance and re-pricing benefits

• Completed other production projects as assigned.

MAIL ROOM CLERK 04/2007 to 01/2009

March Vision Care Inc. - Los Angeles, CA

• Picked up incoming mail and delivered materials to designated locations.

• Dropped off outgoing mail/packages.

• Sorted and scanned incoming claims.

• Data entry corrections to scanned claims.

• Receive and load eligibility files.

• Helped the call center answer phones.

• Send emails and faxes.

EDUCATION

Palmdale High School - Palmdale, CA High School Diploma

1997



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