Florence Mkakazi Mwaila
Claims Reviewer | Customer Service Representative
Nairobi
Summary
Detail-oriented Claims Reviewer and Customer Service Representative with extensive experience in hospital operations, insurance claims review, and patient support services. Expertise in auditing, validating, and ensuring the accuracy of healthcare claims while maintaining strict policy compliance and correct ICD-10, CPT, and HCPCS coding prior to submission. A strong background in hospital customer service facilitates effective communication and issue resolution for patients, insurers, and clinical teams. Recognized for significantly reducing claim denials, improving reimbursement outcomes, and enhancing overall patient satisfaction.
Overview
6
6
years of professional experience
2
2
Languages
Work History
Claims Reviewer
Avenue Hospital
08.2025 - Current
- Reviewed clinical documentation and insurer requirements, reducing claim rejections by 30%.
- Verified ICD-10, CPT, and HCPCS codes, improving coding accuracy by 35%.
- Ensured compliance with insurance policies and benefit limits, increasing first-pass approvals by 25%.
- Analyzed claim error trends and supported corrective actions, reducing repeat errors by 20%.
- Maintained compliance with billing regulations, insurer guidelines, and internal procedures.
Customer Service Representative
Avenue Hospital
09.2019 - 08.2025
- Assisted patients with hospital services, insurance processes, billing inquiries, and appointments.
- Coordinated communication between patients, clinical staff, insurers, and billing teams.
- Resolved patient inquiries and complaints professionally while maintaining confidentiality.
- Verified patient demographic and insurance information to reduce service delays and billing errors.
- Supported admissions and front-desk operations and maintained accurate service records.
Education
Diploma - Information Technology
Nairobi Aviation College
01.2008
Skills
Medical claims analysis
Quality assurance in claims
ICD-10 coding expertise
Insurance policy analysis
Claims documentation review
Accomplishments
- Reduced insurance claim denials by 30% through effective pre-submission reviews.
- Improved first-pass claim acceptance rates by 25%, supporting faster reimbursements.
- Enhanced patient satisfaction by delivering timely, accurate, and professional customer service.
Personal Information
- Available: Available to Work Across All Time Zones
- Nationality: Kenyan
- Availability: Available to Work Across All Time Zones
Timeline
Claims Reviewer
Avenue Hospital
08.2025 - Current
Customer Service Representative
Avenue Hospital
09.2019 - 08.2025
Diploma - Information Technology
Nairobi Aviation College