MAIEL P.
Mid-Level Healthcare Claims Specialist
Open to offersNew to PlatformAbout
Maiel P. is an experienced Customer Service Representative with a focus on the healthcare, dental insurance, pharmaceutical, and e-commerce sectors. From 2013 to 2025, Maiel worked with companies such as Sitel, Cognizant, AGENTS ONLY, and MedVA, demonstrating expertise in claims processing, insurance verification, and denial management. Maiel’s responsibilities have included handling medical and dental insurance eligibility, submitting prior authorizations, preparing and resubmitting insurance claims, assisting with grievance and appeals, and resolving billing discrepancies. In addition, Maiel contributed as a Senior Process Executive/Subject Matter Expert and provided support as an E-commerce Virtual Assistant, delivering order processing and CRM/database management. With proficiency in tools like CRM systems, Zendesk, EHR/EMR, and Google Workspace, Maiel consistently ensured accuracy, compliance, and operational efficiency in insurance and customer service processes.
Experience
Medical Virtual Assistant
MedVA · 2023 — 2025Submitted prior authorizations for approval and followed up with insurance companies. Maintained accurate data records for billing, patient accounts, and insurance information, ensuring compliance with HIPAA regulations.Customer Service Representative
AGENTS ONLY · 2021 — 2023Provided email support and handled order processing tasks. Updated CRM and database information, demonstrated attention to detail, and managed data entry responsibilities.Senior Process Executive / Subject Matter Expert
Cognizant · 2016 — 2021Evaluated Pharmacy's approval for prescriptions and addressed escalated calls and emails from members and providers. Reviewed grievances and appeals, processed claims for maximum reimbursement, identified submission errors, and managed denial appeals by researching billing errors.Customer Service Representative
Sitel · 2013 — 2016Handled medical and dental insurance eligibility and benefits, processed claims, resolved billing denials, and assisted with insurance verification. Prepared and submitted claims to insurance companies, called patients to communicate laboratory results, and managed incoming and outgoing calls.
Skills & Expertise
Education
- Marketing ManagementCentro Escolar University · 2011 — 2014
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