Karem Perez
Brampton,Canada
Summary
Detail-oriented Claims Analyst with experience in medical and dental claims adjudication, claim processing, provider verification, and member eligibility review. Experienced in reviewing and adjudicating claims for multiple benefit groups while ensuring claims are processed accurately and in accordance with plan provisions. Strong attention to detail, confidentiality, problem-solving, and customer service skills. Bilingual in English and Spanish.
Overview
4
4
years of professional experience
Work History
Claims Analyst
Cowan Benefits
Cambridge, Ontario
09.2025 - Current
- Review and process medical claims for different groups.
- Validate eligibility, coverage and supporting documentation to ensure accurate adjudication.
- Processed all claims in compliance with industry regulations, privacy laws, and company standards, ensuring adherence to best practices.
- Collaborated with team members to promptly resolve complex claims issues, enhancing overall claims processing efficiency.
- Maintained accurate records and documentation for audits and reports, supporting compliance and operational transparency.
Claims Adjudicator
BPA Groups at LiUNA Local 183
Vaughan, Ontario
03.2022 - 08.2025
- Analyzed and adjudicated dental paper and electronically submitted claims, maintaining a claim assessment quote of 160 claims per day based on claim complexity.
- Communicated with providers and members through email and telephone to address inquiries and provide assistance.
- Verified member benefit eligibility on MEBS to ensure accurate claim processing.
- Verified member benefit eligibility using MEBS to ensure accurate processing of claims.
- Maintain member's record private and confidential.
Education
Seneca College - International Business
Seneca College
Toronto, ONSkills
- Claims Processing
- Claims Administration
- MS office
- Bilingual
- Efficient
- Organized
- Responsible
- Goal Oriented
Timeline
Claims Analyst
Cowan Benefits
09.2025 - Current
Claims Adjudicator
BPA Groups at LiUNA Local 183
03.2022 - 08.2025
Seneca College - International Business
Seneca College