PROFESSIONAL SUMMARY

SKILLS

WORK HISTORY

Yvette Galaviz

***** ********** **, ******, ** 91342

818-***-**** ac97hy@r.postjobfree.com

Hardworking customer service professional knowledgeable about insurance claims processes. Seeking a permanent role with room for advancement.

• Excellent sense of direction

• MS Office

• Excellent time management

• Fast learner

• Personable

• Computer-savvy

• Time management

• Medical terms and procedure knowledge

• Health insurance industry knowledge

• Customer service-oriented

• Organized

• Medicare and Medicaid process

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.

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

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• Reviewed claims that were pending anf 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.

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

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• 100% adudit 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.

EDUCATION

• Helped the call center answer phones.

• Send emails and faxes.

Palmdale High School - Palmdale, CA High School Diploma 1997

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