Edna Gonzalez

• Assisted clients with daily living needs to maintain self-esteem and general wellness.
• Entertained, conversed, and read aloud to keep patients mentally alert.
• Assisted clients with self-care, hygiene and provided companionship.
• Maintained a clean, safe, and well-organized patient environment.

● Identified medical and non-medical domestic provider networks assigned by region.

● Strengthened relationship building activities while meeting the functional strategy of the Regional, Central Medical Management, and support team.

● Maximized cost containment and financial savings impact, including repricing and negotiating medical claims.

● Ensured direct billing and/or discount agreements were implemented in the assigned regions, while staying competitive in the marketplace.

● Negotiated discounts with foreign providers, and secured direct contracts.

● Provided regional and local medical cost analysis while supporting global business units in maintenance and development of new business opportunities.

● Responded to inter-department inquiries and escalations in a proficient and timely manner.

● Processed department reports and assigned work to colleagues.

● Processed out of country travel insurance claims, including trip interruption/cancellation, baggage,dental, medication, and vision claims up to the designated limit.

● Adjudicated claims according to various benefit policies.

● Thoroughly conducted research through policies and flip charts to provide further information needed to accurately adjudicate claims.

● Maintained accurate documentation on all claims files

● Adjusted reserves in accordance with the insurers guidelines, facilitated stop payment requests and processed reissues accordingly.

● Responded to inter-department inquiries and escalations in a timely manner.

● Reviewed the Supervisor Manager Reports and fulfilling claims.

● Handled coordination of benefits, ensuring all work complied with the PIDEDA and HIPAA

● Assigned work to examiners and trained new associates.