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Ninoshka Burke

@ninoshkaburke

Healthcare claims professional leveraging Medicare/Medicaid expertise to process accurate reimbursements and improve efficiency.

United States

Message

What I'm looking for

I’m looking to use my claims processing and analysis skills to ensure accurate coding, benefit determinations, and compliant payments, while learning under direct supervision and improving operational efficiency and accuracy.

I’m a Claims Processor III with experience coding and processing claims forms, making benefit determinations, and re-entering claims using the PAC process for adjustments on original and reopened claims. I maintain accurate records of claims and communications while researching and resolving claims issues to strengthen payment accuracy and operational efficiency.

Before healthcare claims, I built a strong leadership foundation as a Store Manager/Assistant General Manager with a “customer shopping experience” focus—driving sales, forecasting goals, training associates, and improving service quality. I bring bilingual English/Spanish communication, policy compliance awareness, and proficiency across Microsoft Office (Word, Excel, PowerPoint, Access) to deliver detail-oriented, compliant results.

Experience

Work history, roles, and key accomplishments

Current

Claims Processor III

Current

Elevance Health

Oct 2022 - Present (3 years 5 months)

Code and process healthcare claims by verifying required information prior to payment and maintaining accurate records in line with company policies. Perform benefit determinations and re-enter claims via PAC for adjustments, researching claim issues to support compliance and reimbursement accuracy.

Claims Processing PACS Benefit Determination Coordination Of Benefits Medicare And Medicaid Healthcare Billing Compliance Data Entry

Payment Auditor

Management Service Network

Dec 2021 - May 2022 (5 months)

Audited supplier and reimbursement payments by reviewing pay actions and ensuring completeness, accuracy, and regulatory compliance of pay authorization documents. Entered pay transactions into an automated pay system and provided one-on-one support to service members and annuitants regarding pay entitlements and adjustments.

Claims Pay Authorization Compliance Document Authentication Data Entry Customer Support

Assistant General Manager

Stein Mart

Jul 2017 - Feb 2019 (1 year 7 months)

Supported store operations by coaching teams, improving customer experience, and helping drive sales through action plans and sales forecasting. Managed inventory control, ensured health and safety compliance, and executed merchandising campaigns and promotions while maintaining accurate pricing and displays.