Detail-oriented Healthcare Insurance Specialist with 3+ years of experience in member services, claims review, eligibility verification, and benefits administration. Skilled in analyzing medical claims, resolving member inquiries, processing payments, reviewing claim denials, and coordinating claim adjustments. Strong knowledge of HIPAA regulations, healthcare insurance policies, and customer service best practices. Proven ability to ensure accurate claim resolution while maintaining compliance and delivering exceptional member support.
## CORE COMPETENCIES
* Claims Review & Processing
* Member Eligibility Verification
* Benefits Explanation
* Healthcare Insurance Operations
* Claims Denial Analysis
* Claims Adjustment Coordination
* HIPAA Compliance
* Payment Processing
* Customer Service Excellence
* Issue Resolution
* Documentation & Record Management
* Medical Terminology
* Data Entry & Accuracy
* Regulatory Compliance
B2 SPANISH SPEAKER
## TECHNICAL SKILLS
* Claims Management Systems
* CRM Software
* Microsoft Office Suite
* Healthcare Insurance Platforms
* Data Entry & Documentation Systems
