Paulo
Healthcare Customer Service Representative / Healthcare Claims Specialist
Overview
Looking for part-time work (4 hours/day)
at $4.98/hour ($480.00/month)
Bachelors degree
Last Active
June 23rd, 2026 (yesterday)
Member Since
July 7th, 2025
Profile Description
Key Responsibilities & Achievements:
Processed and reviewed healthcare claims to ensure accuracy, completeness, and compliance with payer and client requirements.
Conducted medical claims data validation by verifying member demographics, eligibility, provider information, diagnosis codes, and claim details before adjudication.
Handled patient and insurance data processing while maintaining strict adherence to HIPAA regulations and healthcare privacy standards.
Investigated and resolved claim-related inquiries, including denied, rejected, pending, and underpaid claims.
Coordinated with insurance payers, providers, and internal departments to facilitate claim resolution and reimbursement processing.
Performed claims accuracy reviews to identify discrepancies, data entry errors, and missing documentation that could impact reimbursement.
Supported reimbursement activities by monitoring claim status, payment processing, and benefit determination.
Assisted in reducing claim rejections through thorough documentation review, data verification, and proactive issue identification.
Managed claim escalations and complex cases requiring detailed research and cross-functional collaboration.
Maintained accurate healthcare documentation, case notes, and tracking records within designated systems.
Generated reports and analyzed claim trends to support operational improvements and quality assurance initiatives.
Participated in process improvement efforts that enhanced claims processing efficiency, turnaround time, and customer satisfaction.
Ensured compliance with healthcare regulations, payer guidelines, company policies, and HIPAA requirements.
Tools & Systems Used
Claims Management Systems
Electronic Health Records (EHR/EMR)
Healthcare Eligibility and Benefits Platforms
CRM Systems
Microsoft Excel (Data Validation, Reporting, Tracking)
Microsoft Office Suite
Internal Claims Processing and Case Management Tools
Top Skills
Office and Administration » Data Entry
Experience: 2 - 5 years
Accurate and efficient Data Entry Specialist with 5 years of experience managing high-volume data input in fast-paced environments. Skilled in entering, updating, and maintaining records across various systems with strong attention to detail and a commitment to data integrity. Proficient in tools such as Microsoft Excel, Google Sheets, and CRM platforms like Salesforce. Known for meeting daily productivity targets while maintaining a high level of accuracy. Dependable, organized, and able to handle confidential information with discretion.
Other Skills
Customer Support » Insurance » Insurance Verification
Experience: 1 - 2 years
Responsible for verifying patient insurance coverage and eligibility through payer portals, phone calls, and internal systems prior to appointments or procedures. Maintain up-to-date records in systems such as Salesforce and EMR platforms. Ensured all verifications complied with HIPAA standards and organizational guidelines.
Basic Information
- Age
- 36
- Gender
- Male
- Website
- Sign Up with Pro Account to View
- Address
- Quezon City, Metro Manila
- Tests Taken
- None
- Government ID
- Sign Up with Pro Account to View
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