Enock mbombi

I’m a detail-oriented Claims Professional with over 6 years of experience in medical and insurance claims processing, including a U.S.-based healthcare environment. Currently, I process high volumes of claims with a strong focus on accuracy, compliance, and turnaround times.

In my current role as a Claims Analyst (Leading Edge Administrators), I process and assess medical claims across U.S. payers including Cigna, Anthem, Medicare, Medicaid, and commercial plans. I review documentation for accuracy, completeness, and compliance, investigate discrepancies, and support insurance verification by reviewing eligibility, coverage, and required documentation. I maintain accurate records in CRM and claims systems while ensuring timely processing in line with SLA deadlines.

Previously, as a Claims Assessor (Batsumi Claims Management Solution), I assessed motor vehicle accident-related medical claims submitted to the Road Accident Fund (RAF). I verified documentation, conducted telephonic statements, handled high volumes of queries from hospitals, attorneys, and patients, and generated reports on claim volumes, outcomes, and outstanding documentation—always ensuring confidentiality and regulatory compliance.