Efficient Claim Adjudicator and Customer Specialist

JoAnn Rodriguez

773-***-**** — Crown Point, IN - 46307 — ********@*****.***

SUMMARY

Efficient and detail-oriented processor with strong skills in data entry, document verification, and quality control. Skilled at maintaining accuracy and speed while ensuring compliance with company standards, demonstrating solid work ethic and conscientious approach to tasks.

PROFESSIONAL SKILLS

• Google docs

• Team Collaboration

• Telephone Etiquette

• Empathy Display

• Active Listening

• Customer service

• Teamwork and collaboration

• Quick Response

• Data Collection

• Attention to Detail

• Problem Solving

• Positive Attitude

• Patience Maintenance

• Multitasking and organizing

EXPERIENCE

Claim Adjudicator/ Customer Service Rep Apr 2006 – Jul 2024 Administrative District Council 1 Welfare Fund Elmhurst, Illinois

• Ensured compliance with applicable laws, regulations and industry standards related to customer service operations.

• Developed strong customer service skills through providing effective solutions to customer inquiries.

• Demonstrated excellent communication, interpersonal and problem-solving skills while interacting with customers on the phone and in person.

Claim Adjudicator Apr 2006 – Jul 2024

Administrative District Council 1 Welfare fund Elmhurst, Illinois

• Evaluate diagnoses, Reviewed and processed Medical, Dental, Vision, HRA, DME, Medicare, Subrogation Claims process short term Disability claims. Verify procedures Participant / Dependent Eligibility.

• CPT codes and ICD10, Knowledge of coding and modifiers (HCPCS), UBO4 and CMS1500, and other submitted data to determine if, additional information is needed to adjudicate the claim. Collaborated providers, policy holders, other insurance companies to obtain additional information.

• Working knowledge and experience with Eligibility, interpretation of the benefit plans, limitation, exclusions, and Schedule of benefits.

• Utilize communication skills between departments to ensure smooth workflow process that reduced claim processing time. increasing overall productivity.

• Ensured compliance with applicable laws, regulation, And industry standards.

• Demonstrated excellent communication and interpersonal skills when dealing with Participants and Providers. Medical and Dental Processor Mar 1988 – Mar 2006

Zenith Administrator Chicago, Illinois

• Followed company standards by maintaining awareness of surroundings and exercising good judgment.

• Processed Medical and dental Vision claims accurately and timely fashion.

• Utilized communication skills between departments and ensure smooth workflow processes.

• Focused on quality and accuracy when processing the claims. EDUCATION

High School Diploma Jun 1986

Steinmetz HS Chicago

LANGUAGES

• Spanish: Fluent

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