Open to opportunities

Amanda Chin

@amandachin1

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Detail-oriented health insurance claims specialist with proven accuracy and process improvement.

United States

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What I'm looking for

I seek a role where I can apply claims adjudication expertise, improve payment integrity, collaborate cross-functionally, and grow into higher-impact operational or policy-focused responsibilities.

I am a detail-oriented and dependable health insurance claims specialist with over 15 years of experience adjudicating commercial, Medicare, and Medicaid claims. I consistently achieved 98% accuracy handling high-cost, complex claims, improved payment integrity using tools like NetworX Pricer and Trizetto, and reduced exceptions and turnaround times through cross-functional collaboration.

I bring strong regulatory and policy knowledge, bilingual English/Cantonese communication, and a track record of operational improvements — including a 20% pricing accuracy improvement and a 50% reduction in member pend exceptions for key accounts. I volunteer actively in community programs and contribute to recognition and quality initiatives within my organization.

Experience

Work history, roles, and key accomplishments

Claims Specialist

Point32Health

Jan 2015 - Jan 2025 (10 years)

Adjudicated 50+ high-cost, complex medical claims per day with 98% accuracy, eliminating backlog and improving pricing accuracy by 20% through validation with NetworX Pricer and Trizetto. Reduced member pend exceptions by 50% and streamlined turnaround times via cross-functional process improvements.

Trizetto Payment Integrity Fraud Detection Cross Functional Collaboration

Claims Processor

Point32Health

Jan 2010 - Jan 2015 (5 years)

Reviewed and processed medical, hospital, and outpatient claims with 98% accuracy, maintained payment integrity through COB management and eligibility verification, and improved service-level performance by 20% via operational workflow optimizations.

Claims Processing Audit & Compliance Workflow Optimization Provider Relations

Education

Degrees, certifications, and relevant coursework

Roxbury Community College

Certificate, Medical Office Assisting

Completed the ARISE Program with a Certificate in Medical Office Assisting, covering administrative and clinical office skills.

University of Massachusetts Amherst

Bachelor of Arts, Chinese Language & Literature

Activities and societies: Internship at Tufts Health Plan (Spring 2010) assisting with data entry and QA using Formworks; provided administrative support across departments.

Completed a Bachelor of Arts in Chinese Language & Literature, focusing on language, literature, and cultural studies.