Open to opportunities

Ameira Ayesh

@ameiraayesh

Message

Senior claims manager specializing in complex medical and dental adjudication and team leadership.

United States

Message

What I'm looking for

I am seeking a leadership role in claims or benefits operations where I can mentor teams, improve processes, ensure compliance, and drive efficient, accurate adjudication.

I am a Senior Claims Manager with extensive experience reviewing and adjudicating complex medical and dental claims, applying medical necessity guidelines, and implementing cost-containment measures to ensure accurate outcomes. I serve as a subject matter expert supporting teams through training, coaching, and issue resolution.

I have led claims teams at UnitedHealthcare, driven quality and productivity improvements, and managed escalations, appeals, and rework calculations to correct overpayments and underpayments. I also have prior clinical and administrative experience in dental and medical settings, including scheduling, insurance verification, billing, and hands-on patient support.

I prioritize clear communication, process improvement, and mentorship to lift team performance while ensuring compliance with payer policies and regulatory requirements. I seek opportunities where I can leverage my technical claims systems knowledge and leadership to improve operational efficiency and member outcomes.

Experience

Work history, roles, and key accomplishments

Current

Lead Technical Claims Manager

Current

UnitedHealthcare

Sep 2023 - Present (2 years 6 months)

Lead review and adjudication of high-complexity medical and dental claims, implemented cost-containment measures and performed rework calculations to correct overpayments/underpayments while training and mentoring claims specialists.

Claims Adjudication Overpayment Recovery Mentoring Process Improvement Eligibility Verification MS Excel Claims Systems Quality Assurance

Dental Benefit Support Case Manager

UnitedHealthcare

Jan 2023 - Sep 2023 (8 months)

Led a team of claims examiners processing dental and medical adjustments, provided SME support for escalations and appeals, and drove workflow improvements to reduce rework and meet productivity goals.

Claims Management Appeals Team Leadership Performance Monitoring Workflow Optimization Customer Service Claims Systems

Geriatric/Pediatric Scheduler

Maimonides Medical Center

Jan 2020 - Dec 2022 (2 years 11 months)

Scheduled and managed patient appointments, verified Medicare and commercial insurance coverage, performed medical necessity checks, and handled appeals and accounts receivable follow-up to resolve denied claims.

Scheduling Insurance Verification Appeals MRN Management Accounts Receivable

Dental Assistant / Office Manager

Todays Dental Group

Apr 2017 - Dec 2019 (2 years 8 months)

Performed clinical delegated procedures and radiographs, managed administrative operations, resolved billing issues, processed adjustments, and ensured compliance with payer agreements.

Office Management Insurance Verification Patient Relations Compliance

Senior Customer Service Rep

House of Styles

Dec 2016 - Mar 2017 (3 months)

Resolved escalations, refunds, and operational issues while managing customer flow across multiple systems to deliver high-quality, multi-channel customer service.

Customer Service Escalation Management Conflict Resolution Communication CRM Tools

Dental & Medical Assistant

5th Avenue Dental and Medical

Dec 2014 - Nov 2016 (1 year 11 months)

Oversaw daily clinic operations at a dental implant center, coordinated scheduling, maintained patient records, managed billing and insurance claims, and supported patient satisfaction.

Clinic Operations Patient Scheduling Billing Insurance Coordination Patient Relations Records Management