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Dalitza
Medical Insurance Claims Analyst
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Competencies
Experiencia demostrada en Claims Analysis.
Experiencia demostrada en Medical Expense Reimbursement.
Experiencia demostrada en Pre-authorizations.
Experiencia demostrada en Insurance Policy Administration.
Experiencia demostrada en Client Support.
Education
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Summary
Perfil profesional
Experience
Medical Insurance Claims Analyst
Analyze daily medical insurance claims to determine coverage and indemnity payments. Review policy terms, exclusions, and benefits to ensure accurate claim resolutions. Submit and manage pre-authorizations with multiple insurance carriers. Review rejection and return letters and communicate resolutions to clients. Provide support to internal teams, brokers, and external clients
Admissions & Medical Billing Representative
Managed patient admissions across multiple hospital departments. Processed billing for emergency and surgical services. Handled national and international medical insurance claims. Verified copayments, deductibles, coinsurance, and non-covered expenses
Medical Claims Adjuster
Process and settle medical expense claims submitted to the brokerage. Notify clients regarding claim status, adjustments, and final resolutions. Verify correct application of payments and reimbursements. Resolve client inquiries related to medical claims
Analista de reclamos senior gastos médicos
Análisis y gestión de reclamos de gastos médicos. Revisión de coberturas y exclusiones. Envío de preautorizaciones. Atención a clientes. Manejo de cargas masivas en sistema mediante Excel
Liquidadora de reclamos gastos médicos
Liquidación de reclamos médicos. Realización de ajustes. Notificación a clientes. Verificación de pagos. Asegurando procesos precisos y oportunos
Ingreso de pacientes y facturación de servicios médicos
Manejo de seguros nacionales e internacionales. Copagos. Deducibles. Coaseguros. Uso de sistemas de facturación y admisiones propios de la empresa
Secretaria médica
Apoyo administrativo médico. Manejo de expedientes. Atención al cliente. Cobro de servicios. Control de caja