Amber Laguines

Claims Specialist with experience in claims processing, adjudication, and insurance verification. Proven ability to maintain high accuracy, resolve denied claims, and ensure full compliance with Health Insurance Portability and Accountability Act standards. Skilled in managing high-volume workloads in remote environments while meeting strict deadlines and quality benchmarks.

• Processed 50–60 claims daily while maintaining high accuracy
• Reviewed and adjudicated claims to verify coding, billing accuracy, and proper reimbursement
• Maintained 99% accuracy in claims adjudication, reducing rework and audit flags
• Verified insurance eligibility and benefits prior to submission
• Utilized Microsoft Excel, Microsoft office, and internal systems to track claim status, updates, and workflow progress
• Resolved denied and rejected claims, improving approval rates and reducing processing delays
• Maintained 100% compliance with Health Insurance Portability and Accountability Act standards with zero data breaches or audit issues