Tatyana Rivera
Claims Specialist @Ipro
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WORK HISTORY
Claims Specialist @Ipro
Serve as the primary point of contact for appeal and dispute adjudication programsLiaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and case documentationMonitor appeal/dispute status and communications via client portalsConduct initial eligibility reviews and recommend appropriate courses of action to internal teams and leadershipTrack and assign cases using commercial and custom software applicationsCompile and distribute case documentation to billers, coders, nurses, physicians, clinicians, and key stakeholdersMonitor and report on key performance indicators (KPIs), including timeliness, accuracy, quality standards, and contractual deadlinesIdentify workflow barriers, recommend process improvements, and implement approved solutionsPresent case and project updates during team huddles and scrums using an agile, iterative approachSchedule and facilitate team status meetings; document decisions, assigned tasks, and next stepsPrepare billing invoices upon case completion and coordinate with Finance and Accounting to track paymentsMentor and train new staff on processes and case progressionPerform additional duties as assigned
EDUCATION
J.P. Taravella
High School
Azure Tide Realty
Real Estate
Broward College
Associate’s Degree, Liberal Arts and Sciences/Liberal Studies
SKILLS
ABOUT TATYANA RIVERA
I am a Licensed Life, Health, and Accident Insurance Advisor specializing in Benefits Counseling and high-stakes HR operations. My expertise lies in navigating the intersection of complex insurance plans, regulatory compliance, and revenue cycle management.With extensive experience in Claims, Billing, and Prior Authorizations, I bridge the gap between healthcare providers, insurance carriers, and employees. I thrive in high-volume environments where data integrity, HIPAA compliance, and technical accuracy are critical to organizational success.Core Competencies:Claims & Revenue Operations: Expert in auditing patient files, managing prior authorizations, and resolving billing discrepancies to reduce denial rates and optimize reimbursement.Benefits Administration: Comprehensive management of Open Enrollment, Section 125 plans, and voluntary benefits for corporate and union memberships.HRIS & Tech Proficiency: Advanced user of ADP, Salesforce, and Yardi to maintain flawless digital records and secure remote contract execution.Compliance & Fiduciary Responsibility: Strict adherence to HIPAA, ERISA, and state/federal insurance regulations.I am seeking a remote Benefits Analyst, Claims Specialist, or HRIS Implementation Consultant role where I can leverage my insurance licensure and operational rigor to support growth-oriented teams.Licenses & Contact:Licensed Insurance Advisor (Life, Accident, and Health)Reach out via LinkedIn or at (95••••••73.
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