Esea Santiago

Results-driven healthcare insurance specialist with extensive experience working in both hospital and provider office settings. Adapt at navigating the complexities of healthcare insurance processes, including claims management, denial resolution, and payer negotiations. My comprehensive background allows me to anticipate and overcome insurance challenges efficiently, ensuring seamless operations and maximizing revenue.

With a proven track record of optimizing workflows and enhancing overall efficiency, I am committed to delivering exceptional service and driving success in any healthcare environment.

Medical Insurance Specialist at Meadows Healthcare LLC (2025-01 – 2026-07)

Virtual Assistant

• Checking patient insurance, verified benefits such as copay, deductible and coinsurance.
• Submit claims through EHR and payer portals (e.g., Waystar)
• Post payments accurately to patient accounts
• Follow up with insurance companies regarding claim status
• Call patients for updates, clarifications, or follow-ups

Medical Claims Specialist at KMC MAG Solutions (2023-06 – 2025-01)

• Efficiently manage the end-to-end processing of medical claims, ensuring accuracy and compliance with industry standards.
• Utilize established criteria to determine claim eligibility, leading to a timely resolution of payment issues.
• Maintain meticulous records and prepare essential documentation to support insurance claims, enhancing workflow efficiency and reducing discrepancies.
• Provide exceptional support to healthcare providers and patients, answering inquiries with clarity and professionalism while guiding them through the claims process.
• Problem-Solving Skills for Claims Denial, Appeal Dispute and Claim Entry.

Medical Claims Specialist at Med Metrix Inc (2022-09 – 2023-04)

• Proactively handled comprehensive records and ensured documentation accuracy for insurance claims.
• Assessed and processed medical claims, making informed decisions on approvals or denials based on set criteria.
• Prepared precise documentation to support claims while ensuring compliance at every step.
• Deliver high-quality assistance to healthcare professionals and patients by responding to inquiries with clear, professional communication and navigating them through the claims lifecycle
• Apply analytical and critical thinking skills to resolve claim denials, prepare and submit appeals, manage payer disputes, and ensure precise claim submissions

ProviderServiceCenter at Sagility Healthcare (2019-07 – 2022-09)

• Delivered exceptional assistance to healthcare providers, including doctors, nurse practitioners, and midwives.
• Managed accurate records, processed claims, and ensured adherence to industry regulations.
• Assessed claims, made informed payment decisions, and maintained compliance with guidelines.
• Leveraged administrative guidelines to streamline processes and enhance efficiency.
• Provided expert support to ensure a smooth claims processing experience for providers.

Bachelor of Science in Information Technology – Quezon City University (2015 – 2020)