Christine Mendoza
Port Moody,BC
Summary
Detail-oriented benefits and claims professional with experience in extended health claims adjudication, benefits administration, and customer service. Skilled in analyzing complex claims, managing benefit systems, supporting appeals, and identifying potential fraud. Strong communicator known for accuracy, problem-solving, and delivering high-quality service in regulated, fast-paced environments.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Benefit Representative, Extended Health Claims
Pacific Blue Cross
07.2024 - 07.2025
- Maintain and update the ACES drug formulary system, ensuring accurate claim adjudication.
- Set up new drugs and service code groups in the system.
- Conduct research on foreign, compounded, and off-label drugs to determine eligibility.
- Initiate and receive phone calls, emails, and written requests for assistance.
- Create written requests for additional information from members and document for follow-up by the relevant internal department or contact.
- Support the Benefits Review Committee in assessing member appeals on denied claims, service quality, contract concerns, and administrative issues. Reconstruct and transfer member claims histories across benefit plans and policies.
- Transfer member claims history between benefit plans and/or policies and initiate manual review changes in ACES.
- Handles Member Claims History, Claims History Transfers and Manual Review Structure
Benefit Claims Examiner, Extended Health Claims
Pacific Blue Cross
11.2023 - 07.2024
- Manually adjudicate complex extended health claims
- Analyzes and examines a wide range of extended health benefits claims
- Process pre-authorizations, adjustments, and investigate escalated complaints.
- Monitors the potential for fraudulent claims by identifying anomalous, suspicious or unusual claims activity.
- Respond to inquiries about adjudication procedures from internal and external contacts
- Performs other assigned duties related to the provision of claims adjudication, administrative and/or clerical support.
Customer Service Representative
Pacific Blue Cross
11.2020 - 10.2023
- Provides inbound and outbound call centre services to members, plan administrators, service providers, employers, and government agencies for a diverse range of group and individual dental, extended health, and travel benefit plans
- Provides support and shares knowledge with team members regarding inquiries, escalations, and navigation through company software and resources.
- Monitor and identify potential fraudulent claims.
- Support new employees in their training and development.
- Maintain up-to-date knowledge of benefit plans and claims processing rules and policies.
Customer Service Representative
Alberta Blue Cross
06.2018 - 11.2019
- Delivered front-line service to individual, group benefit plan members and government-sponsored health programs.
- Educating members on plan details, claiming procedures, and the use of the online member site/mobile app.
- Researching and analyzing root causes of issues, and independently deciding how to handle unique situations within contract guidelines.
- Suggesting workflow improvements and ensuring complete follow-up on customer requests.
Administrative Support V
Alberta Health Services
04.2012 - 06.2018
- Supported pharmacy operations of Royal Alexandra Hospital and Glenrose Rehabilitation Hospital
- Calendar & Email Management: Schedule appointments, manage calendars, and handle email inboxes.
- Records & File Management: Maintain organized records and files like annual drug usage
- Meeting Support: Prepare materials, agendas, and take minutes during meetings, follow up on action items, and support initiatives.
- Administrative Inquiries: Respond to daily administrative questions and requests. Research and track action items; respond to requests/complaints.
- Correspondence: Compose, proofread, and format memos, letters, and other correspondence.
- Office Supplies & Payroll: Order office supplies and manage payroll.
Education
Medical Transcriptionist Certificate -
Canscribe Career College
Kelowna, BC01.2016
Bachelor of Science - Entrepreneurship
Miriam College
Metro Manila, Philippines01.2005
Skills
- Customer Service & Communication
- Claims Adjudication & Analysis
- Claims & Benefits System Management
- Fraud Detection & Risk Management
- Research & Problem Solving
- Team Support & Leadership
- Administrative & Organizational Skills
- Workflow Optimization & Improvement
Certification
Completion of Learning as Leaders program, facilitated by Pacific Blue Cross.
Timeline
Benefit Representative, Extended Health Claims
Pacific Blue Cross
07.2024 - 07.2025
Benefit Claims Examiner, Extended Health Claims
Pacific Blue Cross
11.2023 - 07.2024
Customer Service Representative
Pacific Blue Cross
11.2020 - 10.2023
Customer Service Representative
Alberta Blue Cross
06.2018 - 11.2019
Administrative Support V
Alberta Health Services
04.2012 - 06.2018
Bachelor of Science - Entrepreneurship
Miriam College
Medical Transcriptionist Certificate -
Canscribe Career College