Paula Saenz Email & Phone Number

Westlake, Texas, Us

Effectively managed and evaluated risk when reviewing money movement requests including but not limited to check request, check deposit, contributions to retirement account. Actively completed research assessing clients needs.

Reviewed Medical and Behavioral health insurance claims for accuracy and completeness as well as eligibility. Participated in audits coordinating with compliance and legal to ensure provided all the requested data before being sent to the Department of Insurance. Navigated through different systems such as Genelco, OI portal, care radius, EMDI, and used excel spreadsheets.

Phoenix, Az, Us

o Utilized various software applications in use at TriWest.o Understood procedures and processes of the VA program.o Performed claims research, including interpreting VA policies, investigating automated transactions, documenting outcomes, updating records and reporting accurately on research findings.o Resolved incorrect claims processing, calls providers for Missing claims and medical documentation to resolve Veteran billing issues.o Reviewed authorizations to establish ancillary providers associated and obtain claims missing for payment.o Answered inbound calls from Veterans and providers in a timely manner.o Consistently displayed professional and courteous service skills to internal and external customers.o Responded to inquiries from Veterans and providers regarding specific aspects of the VA program. Information and assistance includes providing details about referrals, authorizations, claim status and billing discrepancies.o Protected the privacy of health information of patients when using or disclosing Protected Health Information (PHI). PHI is any information about health status, or healthcare services that is linked to an individual.o Took appropriate measures to comply with HIPAA regulations to protect privacy of beneficiaries' health information.o Documented all communications involving Veteran and provider contacts.o Coordinated complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialist and other departments.o Understood and utilized the grievances and appeals process available to dissatisfied beneficiaries and providers.

El Paso, 79905, Us

El Paso, Tx, Us

Responsible for claim monitoring and administrative report generation. Communication with claimants, providers, claims examiners and lawyers. Run eligibility coverages and check for authorizations. Advised of eligible ICD 10, CPT and HCPCS codes for claimants under their treatment suites. Stayed current of HIPAA regulations, benefits claim processing, medical terminology, and other procedures. Accurately processed large volume of medical claims every shift. Evaluated pending claims to identify and resolve problems blocking auto adjudication. Reviewed claims for accuracy before submitted for billing.

Tampa, Florida, Us

I currently work from home and take calls for AARP members. I renew memberships, make changesnecessary to the members profiles, transfer calls to independent service providers and researchinformation member may need.

Bloomington, Illinois, Us

Provide basic information about insurance policies to customers and answers any inquiries. Helpedcustomers with filing new claims or, make changes to their existing policies. Sold Homeowner’s, andauto insurance to new customers and upgraded policies for existing customers. Handled phones,deliveries emails and updating office file supplies on a daily basis. Assisted Manager, agent, and otherpersonnel with administrative tasks. · Reviewed policy to make sure everything was in order and filedpaperwork.

Opened accounts such as checking, savings, money market, certificate of deposits, referrals. Greetedcustomers entering the store to ascertain what each customer wanted or needed.Described product tocustomers and accurately explained details. Answered questions regarding products, while maintainingknowledge of current sales and store promotions. Guaranteed positive customer experiences andresolved all customer complaints. Maintained positive attitude to make customer's experiencesmemorable and pleasant. Helped with processing teller transactions. Processed deposits, withdrawals,issued cashiers checks and money orders. Also helped branch managers with with incoming andoutgoing cash shipments. Counted teller drawers, helped with out of balance end of day counting.

San Francisco, California, Us

Answered customer inquiries, solving problems, and providing new product information. Workedat a Customer service call center as well as in the Branch. Helped with scheduling for my team.Investigated and resolved customer inquiries and complaints in a timely and empathetic manner. Also worked in store branch opened new accounts, helped with teller transactions, and telemarketing.

Worked in an inbound/outbound call center customer service center. Responsible for underwritingrenewals. Made any endorsements needed or cross sales.

Bachelor Of Science - Bs, Hospitality Administration/Management

Medical Insurance Specialist/Medical Biller

Diploma, General Studies