Mary G.
Mid-Level Healthcare Insurance Specialist
Open to offersNew to PlatformAbout
Mary G. is a dedicated Healthcare Insurance Specialist with a strong background in claims processing and policy administration, developed over a robust 4-year career. Specializing in the healthcare sector, Mary possesses expertise in analyzing insurance plans, verifying patient eligibility, and ensuring compliance with critical regulations such as HIPAA and the ACA. At Qualfon, she excelled as a Claims Adjustment Specialist, managing discrepancies, processing accurate claims, and providing logistical solutions within both onshore and offshore domains. Her career path involved roles that honed her strong problem-solving skills, including her tenure as a Medical Biller at Lightfully Behavioral Health, where she ensured precise billing and effective client financial services. Mary is proficient in using various software tools, encompassing Electronic Health Records and claims management systems, which underpin her operational excellence in service delivery and client satisfaction. Her educational background comprises a Bachelor in Elementary Education from Negros Oriental State University. Mary aims to leverage her skills in a dynamic organization that values patient care and financial diligence.
Experience
Medical Biller/ Client Financial Services Specialist
Lightfully Behavioral Health – Work from home set up · 2025 — 2026Oversaw patient billing, insurance claims, and payment collection to facilitate timely revenue for healthcare providers. Managed appointment scheduling and maintained patient confidentiality.Senior Escalation Credentialing Specialist
Robert Wood Johnson University Hospital – New Jersey Lunas Solution – Work from home set up · 2025 — 2026Responsible for processing credentialing and recredentialing applications for healthcare providers. Managed escalation requests from providers with denied applications.Health Care Specialist and Claims Adjustment Specialist
Qualfon- Horizon Blue Cross Blue Shield of New Jersey · 2021 — 2025Provided member and provider services, addressing customer complaints and inquiries regarding billing, enrollment, benefits, and claims. Maintained records of interactions and ensured adherence to communication guidelines.Claims Adjustment Specialist
Braven Health · 2023 — 2025Promoted to manage claim discrepancies, processing tasks for both onshore and offshore operations. Responsible for sending daily claims inventory reports and ensuring claims accuracy.SiriusXM Account Specialist
The Results CX - Mactan Newtown One World Center · 2016 — 2021Handled escalated customer calls and addressed billing inquiries to ensure customer satisfaction. Verified functionality of customer SiriusXM satellite radios and worked to prevent subscription cancellations.Business Process Associate (Admin Advantage)
Manulife John Hancock – Mactan Newtown · 2021 — 2021Managed administrative tasks and back office functions, processing enrollment applications and beneficiary forms for Canadian members. Responsible for weekly reporting on new enrollments and resolving claims discrepancies.Practice Teaching
Basak Elementary School · 2015 — 2016Engaged in practice teaching to apply learning in education and subject matter. Developed critical thinking skills, planned for student needs, and managed various personalities to create a productive environment.
Skills & Expertise
Education
- Bachelor in Elementary Education- Major in General CurriculumNegros Oriental State University - Guihulngan City · 2012 — 2016