A seasoned professional with over 14 years of experience in the U.S. health insurance industry, specializing in medical claims processing, quality assurance, and administrative support. Throughout my career, I’ve handled a wide range of responsibilities including:
- Medical Claims Processing – Accurate and timely review of claims following U.S. healthcare guidelines and payer policies.
- Quality Assurance Analyst – Responsible for performing quality checks on the Part D grievance process, document processing, billing, reconciliation, and plan enrollment to ensure workflows are in accordance with plan rules and compliant with CMS regulations.
- Document, File Management, Eligibility Verification - Experienced in managing enrollment files, verifying member's eligibility, and reconciling discrepancies between client and payer systems.
Administrative & VA Tasks – Calendar/email management, data entry, customer service, documentation, and other back-office support tasks for healthcare clients.
Tools & Platforms:
Facets / Pharmacy Benefits system
Microsoft Office (Excel, Outlook, Word)
Google Workspace (Docs, Sheets, Gmail)
Zoom, Canva, Hubspot, Availity, Epic
Verified