Melissa Maria Munoz
Oakley
Summary
Skilled in both processing and analyzing medical claims within insurance industry. Experience includes verifying accuracy of health care billing, negotiating and assessing claim settlements. Strengths lie in understanding complex medical coding systems, strong analytical skills, and comprehensive knowledge of healthcare regulations. Past roles have led to improved efficiency in highly collaborative style with strong networking skills across business functions ensuring cost-effective outcomes for clients.
Analytical professional in the insurance investigation field known for high productivity and efficient task completion. Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills.
Overview
14
14
years of professional experience
Work History
Medical Claims Examiner
Health Service's & Benefit Administrator, Inc.
Dublin
02.2017 - Current
- responsible for multiple job duties assigned by my Claims Director such as the Health Reimbursement Account (HRA), Third-Party Liability Claims (TPL), and additional claim medical reimbursement benefits.
- Review all HRA claims to insure we are complying with IRS regulations and Plan rules.
- TPL claims investigate and streamline medical claims in relation to third party accidents and create liens for subrogation.
- Communicate effectively with attorney via phone, via fax and email response.
- Medical claim processing for Anthem as needed.
- I have knowledge of CPT codes, ICD-10 Codes and Medical Terminology.
- Maintained updated knowledge of changes in healthcare regulations impacting claims processing.
- Collaborated with internal departments such as billing, customer service, and IT.
- Participated in process improvement initiatives aimed at streamlining workflow processes.
- Reviewed and processed medical claims for accuracy and completeness according to established guidelines.
- Ensured HIPAA compliance by maintaining strict confidentiality of patient information.
- Conducted periodic reviews of rejected and denied claims to identify patterns or trends in rejections.
- Provided training and guidance to new staff members on procedures related to claim processing.
- Verified insurance coverage and eligibility of patients for services rendered.
- Investigated discrepancies in claims data, reconciled errors, and corrected inaccuracies as needed.
- Performed audits of submitted claims to validate accuracy of payment calculations.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Analyzed information gathered by investigations and reported findings and recommendations.
- Analyzed provider contracts to ensure proper reimbursement levels were achieved.
Universal Banker 1
Mechanics Bank
Pittsburg
11.2015 - 02.2017
- Provided account services to clients by receiving deposits and loan payments, cashing checks, answering general bank questions in person or on the telephone, referring to other bank services such as loans, credit, and checking/savings/IRA accounts.
- Supported the implementation of new systems related to banking operations.
- Provided guidance on establishing automatic transfers between various accounts.
- Researched account discrepancies or errors identified during audits or reviews.
- Cross-sold bank products such as debit cards, credit cards and overdraft protection plans to existing customers.
- Explained banking products and services such as checking accounts, savings accounts, loans and credit cards to potential customers.
- Opened new accounts for customers, including checking accounts, savings accounts and certificates of deposit.
- Processed deposits, withdrawals, loan payments and other financial transactions.
- Maintained records of customer interactions and transactions in accordance with bank policies.
- Educated customers about the features of different types of bank accounts available.
- Performed fraud prevention duties by monitoring suspicious activity on customer accounts.
- Developed relationships with business owners to promote commercial banking services.
- Attended weekly meetings with branch managers to discuss goals related to sales targets.
Head Cashier Manager
Lowes
Antioch
02.2011 - 11.2015
- Managed employee's performance and provided feedback.
- Identified opportunities for improving operational efficiency through process optimization initiatives.
- Performed opening and closing duties such as counting money, balancing tills, and reconciling discrepancies.
- Handled returns, exchanges, and refunds in accordance with company policy while maintaining a high level of customer satisfaction.
- Maintained records of daily transactions including sales receipts, cash received, discounts issued.
- Collaborated with the management team to determine appropriate staffing levels for peak hours.
- Reviewed financial reports on a weekly basis to ensure accuracy of store operations and compliance with company guidelines.
- Coached employees on best practices for handling customer complaints quickly and effectively.
- Assisted other departments when needed by providing additional support during busy periods.
- Ensured all cashiers were trained in store policies and procedures, as well as safety protocols.
- Scheduled and supervised cashiers during shifts, ensuring proper coverage of registers.
- Analyzed sales data to identify trends in customer purchasing behavior that could be used to optimize inventory selection and pricing strategies.
- Assisted management with developing and managing employee improvement strategies to encourage exceptional performance from staff.
- Authorized discounts and special actions to resolve customer disputes and maintain satisfaction.
- Ensured compliance with legal and company policies regarding transactions, returns, and exchanges.
- Resolved customer complaints and issues, ensuring satisfaction and maintaining store reputation.
- Managed cashier team, ensuring efficient transaction processing and high customer service standards.
- Supervised daily cash operations, including opening and closing procedures, cash drawer management, and deposits.
- Trained new cashiers in POS system operation, customer service protocols, and store policies.
Education
General Studies
Los Medanos College
Pittsburg, CA05.2025
High School Diploma -
Pittsburg Senior High School
Pittsburg, CA01.2010
Skills
- Bilingual in Spanish
- Computer efficient in Microsoft Word
- Computer efficient in Microsoft Teams
- Computer efficient in Microsoft Excel
- Computer efficient in Microsoft Outlook
- Administrative Support
- Problem solving
- Critical thinking
- Strong Communication skills
- Analytical skills
- Ability to work under pressure
- Prioritization
- Handling multiple tasks
- Leadership skills
- Strategic decision making
- Conflict resolution
- Adaptability
- Interpersonal skills
- Customer service
- Medical Terminology Knowledge
- Team collaboration
- Leadership development
- Teamwork and collaboration
- Adaptability and flexibility
- Problem-solving
- Customer engagement
Timeline
Medical Claims Examiner
Health Service's & Benefit Administrator, Inc.
02.2017 - Current
Universal Banker 1
Mechanics Bank
11.2015 - 02.2017
Head Cashier Manager
Lowes
02.2011 - 11.2015
General Studies
Los Medanos College
High School Diploma -
Pittsburg Senior High School