Zoey Hageru

[email protected] • 202-556-1564 • Silver Spring, MD. United States

PROFESSIONAL SUMMARY

Detail-oriented Medical Claims Specialist with 3+ years of experience in claims processing, medical billing, and revenue cycle management. Proven track record of achieving high compliance rates, reducing claim denials, and improving workflow efficiency using ICD/CPT/HCPCS coding, EHR systems, and documentation verification tools. Skilled at analyzing claim trends, resolving provider inquiries, and optimizing claims processing to support organizational goals.

WORK EXPERIENCE

Claim Review Specialist
02/2024 - Present
Humana , Remote
• Reviewed and approved 1,500+ medical claims monthly with 98% accuracy, ensuring alignment with payer policies and regulatory requirements
• Resolved provider documentation gaps and coding discrepancies, completing 90%+ of inquiries within SLA
• Assessed ICD, CPT, and HCPCS coding to prevent recurring errors and reduce manual rework
• Coordinated with internal teams to improve routing and processing efficiency across departmental workflows
• Maintained benchmark productivity and compliance metrics in a high-demand claims environment
Claims Operations | Medical Claims Specialist
12/2021 - 01/2023
Bright Health , Remote
• Handled and validated 1,200+ member claims monthly, maintaining 99% compliance during internal audits and regulatory reviews
• Detected coding inconsistencies, contributing to a reduction in downstream appeal volume
• Communicated with providers to secure missing records and clarify treatment details for accurate adjudication
• Managed daily caseloads across multiple claims systems, ensuring timely and policy compliant decisions
• Supported process improvements by documenting frequent denial patterns and recommending corrective actions
Patient Services | Medical Receptionist
03/2021 - 11/2021
Insight Care , Kensington, MD
• Scheduled patient appointments and verified insurance eligibility, improving daily patient flow and reducing check-in wait times by 15%
• Coordinated with providers, patients, and billing teams to streamline check-in workflows and reduce wait-time bottlenecks
• Handled documentation intake and maintained accuracy across patient records and encounter forms

EDUCATION

Associate Degree in Health Information Management
01/2026
Montgomery College , Germantown, MD

SKILLS

Technical Skills: Claims Processing Platforms | EHR Systems | ICD/CPT/HCPCS Coding Tools | Documentation Verification Systems | Workflow Management Platforms | Medical Billing & Coding | Revenue Cycle Management

PROJECTS

Claims Quality Optimization
• Developed a revised documentation checklist after analyzing frequent denial patterns for high-volume claim types, improving initial-pass claim accuracy by 12%

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