Maria J.
Mid-Level Healthcare Claims Examiner
Open to offersNew to PlatformAbout
Maria J. is a distinguished Healthcare Specialist and certified Healthcare Operations & Medical Coding Expert, with over four years of formidable experience in customer support and healthcare operations. Currently serving as a Claim Examiner at Global Clinical Services BPO Inc., she meticulously evaluates insurance claims, ensuring accuracy, eligibility, and compliance with insurance regulations. Previously, Maria excelled as an Email and Chat Support Specialist at Buwelo Exact Star Company, delivering prompt and efficient customer service for a wholesale marketplace using machine learning and data-driven insights. Her foundational skills were honed through a Bachelor of Science in Computer Science, focusing on Network and Data Communication Systems. Maria’s professional journey extends to a Senior Leader and Trainer position in inspection at Sumi Philippines Wiring Systems Corp., where she drove quality compliance and operational enhancements through comprehensive training and meticulous inspections. Her commitment to documentation accuracy and process improvement underlies her contributions to the fields of medical coding, insurance claims, and customer service.
Experience
Healthcare Specialist (Non-voice Agent)
Global Clinical Services BPO Inc. · 2023 — 2026Coded medical procedures accurately using electronic health records to ensure proper documentation. Reviewed and verified insurance claims to facilitate smooth billing and maintained detailed financial records. Conducted outbound calls to confirm patient information, improving data accuracy and transparency.Claim Examiner
Buwelo Exact Star Company · 2021 — 2023Executed evaluations of insurance claims to assess validity and determine compensation levels for policyholders. Verified the accuracy and completeness of claim forms, along with checking claimant eligibility and coverage, while applying the applicable rules and regulations of the insurance plan.Email and Chat Support Specialist
Buwelo Exact Star Company · 2021 — 2021Delivered quick and accurate responses to customer inquiries via email and live chat, ensuring customer satisfaction. Provided support for a wholesale marketplace focused on independent retailers and brands, using data and machine learning to assist small businesses.Inspection Senior Leader/Trainer (QA)
Sumi Philippines Wiring Systems Corp. · 2013 — 2021Conducted thorough inspections to ensure product compliance with established quality standards and performed root cause analysis to promote continuous improvement. Developed training timelines for the team that enhanced skills, accountability, and overall quality performance.
Skills & Expertise
Education
- Bachelor of Science in Computer Science Major in Network and Data Communication SystemBataan Peninsula State University