Glory Njeru

Results-driven professional with extensive experience in insurance verification, claims management, and customer service within dynamic health-care and call center environments. Proficient in evaluating patient insurance eligibility, confirming benefits, and processing claims through advanced insurance portals with precision. Skilled in billing, financial documentation, and ensuring compliance with IRA and HIPAA regulations to maintain data integrity and confidentiality.

Brings a proven track record of delivering exceptional service to high-end clients in call center settings, demonstrating strong interpersonal skills, advanced problem-solving abilities, and a commitment to exceeding client expectations. Skilled at fostering trust and building lasting client relationships by resolving complex inquiries and providing tailored solutions. Excels in utilizing medical terminology, coding, and conducting detailed claims investigations to streamline work flows, enhance service quality, and thrive in fast-paced, high-pressure environments.

A collaborative team player with a passion for driving operational efficiency and ensuring superior client satisfaction.

Eligibility and Benefits Verifier- US Health care Insurance at ADEC INNOVATIONS [AMDATEX] (2024-12 – Present)

• Verifying patient insurance details, including coverage, policy numbers, and pre-authorization requirements.
• Communicating with insurance companies to confirm benefits and update patient records accurately.
• Maintaining proficiency in Insurance Portals, manage care plans, medical terminology, and OTP coding.
• Ensuring compliance with HIPAA policies while managing accurate data entry and record keeping.
• Collaborating with cross-functional departments and actively contributing to organizational committees.

Claims Management Officer- Health Insurance at Neema Universal Hospital (2023-12 – 2024-06)

• Reviewed and validated corporate insurance claims, ensuring compliance with guidelines.
• Gathered necessary documentation and assisted with claims investigations for rejections.
• Communicated claims decisions promptly to the customer care team and handled insurance inquiries.
• Prepared detailed claims administration reports for management.
• Supported the billing department as needed.

Customer Service and Billing Officer at Focus Clinical and Diagnostic Center, Kenya. (2022-06 – 2023-11)

• Interacted with multiple clients and insurance companies through various channels, ensuring seamless communication flow.
• Processed corporate invoices using hospital systems and software, and billed insurance through various portals such as Smart link, Slade, HICS, LCT.
• Collected and analyzed customer feedback to improve service delivery.
• Collected and processed payments through cash and online systems.

Bachelor's Degree in Business Administration – Dedan Kimathi University of Technology, Kenya. (2017-05 – 2021-12)

Computer Studies Certified in Computer Studies (2017-05)

High School Diploma (2016)