darius feliciano

I'm currently resolving complex medical claims at EmblemHealth, managing 100+ claims weekly while meeting quality standards and decision timelines. My documentation and workflow improvements have reduced average claim cycle time by approximately 20%.

I've implemented fraud detection protocols that identified abnormal billing patterns and protected the company from an estimated $50K+ in fraudulent payouts. I also coordinate provider reviews to clarify billing discrepancies and improve reimbursement accuracy.

Previously at CVS Health, I processed high-volume insurance claims with an accuracy rate above 97%. I reduced processing errors by 15% through targeted quality assurance checks and improved adjudication speed through workflow prioritization.

I bring hands-on experience in claims adjudication, medical billing, provider coordination, data analysis, and process improvement. I'm focused on making claims operations more accurate, efficient, and responsive for providers and policyholders.