Ana Ramos

Washington, DC Area

ad2sio@r.postjobfree.com • 301-***-**** • linkedin.com/in/ana-ramos997/

Proven Specialist: Customer Service, Claims Processor, Account Management, Insurance Benefit, Healthcare/Medical Codes

Bilingual and energetic professional with comprehensive skills in customer management, claims processing, benefits operation skils, medical coding, and diverse cross-functional teams to achieve goals. Innovative thinker with health insurance, provider, and patient benefits management acumen. Broad success in executing plans in complex, fast-paced, competitive environments. Convert chaos to performance and complicated topics into simple concepts. Organized, creative problem-solver who excels at completing challenging, agile projects. Builds effective working relationships with colleagues and clients, prioritizing tasks with minimal oversight. Skilled in oral and written communications.

• Benefits, Claims Administration • Contact/Call Center • Health Insurance • Member/Patient, Provider, Payer Relations • Office Administration • Data Input • Invoicing, Billing • Recordkeeping • Training • Customer Relationship Management CRM • Payment Processing • Pharmacy Benefits • Process Improvement, Automation • Microsoft Office • Basys Software • Technology • Problem Solving • Communication • Collaboration • Diversity • People Management • Spanish Language

PROFESSIONAL EXPERIENCE

Local 26 IBEW-NECA Joint Trust Funds, Lanham, MD 1/2007-3/2023

Provides medical, dental, vision, hearing, pharmacy, and retirement benefits to IBEW Local 26 members and their dependents.

Specialist, Medical Claims Processing, 1/2016-3/2023

Researched, verified, and processed health care benefits claims accurately and promptly following benefit plans.

Ensured timely and accurate processing of 100 to 125 claims daily, using attention to detail and analytical skills. 220********

Resolved claim disputes by effectively communicating with healthcare providers and insurance companies using a thorough understanding of medical coding and billing practices.

Processed claim approvals/denials correctly with confidentiality in compliance with internal policies and HIPAA regulations.

Researched ICD-10, HCPCS, and CROSSWALK references for coding medical services and procedures for prices, reporting, discrepancy resolution, and pricing.

Administered claims eligibility, referrals, and refunds, from government (Medicare) and commercial insurance payers.

Communicate with members, healthcare providers, and insurance companies to answer questions and resolve disputes.

Customer Service Representative, 1/2007-12/2016

Managed 50+ daily customer inquiries via phone, email, and chat, focusing on providing excellent customer service.

Provided benefit details, eligibility, and claim status using strong problem-solving skills.

Consistently exceeded performance metrics for call center productivity, customer satisfaction, and quality assurance.

Collaborated with cross-functional teams to ensure prompt and efficient resolution of customer issues.

Utilized effective communication and active listening skills to build rapport with customers.

Managed a high volume of incoming calls and emails while maintaining a professional and courteous demeanor.

Ensured consistency and accuracy by training and mentoring customer service representatives on policies and procedures.

Maintained accurate customer records and updated account information as needed.

Orion Management, College Park, MD 1/2000-12/2006

Administrative Assistant

Greeted and welcomed all visitors, answering inquiries and directing them to the appropriate departments or individuals.

Scheduled and coordinated appointments, meetings, and events for management and staff.

Managed the front desk, ensuring a clean, organized, and professional environment.

Gave administrative support to executives, such as drafting correspondence, managing calendars, and travel arrangements.

Answered and screened phone calls, took messages, and forwarded calls to the appropriate staff members.

Managed and ordered office supplies, ensuring inventory was always organized.

Maintained and updated filing systems, including electronic and paper files.

Handled incoming and outgoing mail and packages, ensuring timely and accurate delivery.