appeals and grievances resume example with 15+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - : - -
Professional Summary

Dedicated customer service offering more than 30 years' experience assisting with collective bargaining, including resolving conflicts and mediating talks. Persuasive negotiator, talented organizer and complex problem-solver. Seeking a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Excellent reputation for resolving problems and improving customer satisfaction.

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Desire to bring skills to new position with room for advancement.

  • Grievance handling
  • Training development
  • Policy interpretation
  • Good telephone etiquette
  • Customer Service
  • Responsible
  • Interpersonal Communication
  • First Aid/CPR
  • Written Communication
  • Compassion
  • Basic math
  • Supervision
  • Data management
  • Type software proficiency
  • Medical Billing and Coding
  • Medical office administration
  • pH testing
  • Medical Records Management
  • Using a centrifuge
  • Assisting with physical exams
  • Patient Scheduling
  • Knowledge of EKG rhythm interpretation
  • Efficient and reliable team player
  • Patient Assessments
  • Phlebotomy
  • Completing Insurance Forms
  • Inventory and Supply Management
  • Infection Control and Aseptic Procedures
  • Simple Dressings
  • Monitoring Patient Progress
Work History
11/2016 to 07/2020
Appeals and Grievances Patterson Dental Supply, Inc. Fort Lauderdale, FL,

I am a team player who can also work independently.

  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Received and processed stock into inventory management system.
  • Exceeded goals through effective task prioritization and great work ethic.
  • Onboarded new temps by entering into Software and setting up in time clock.
  • Actively listened to customers' requests, confirming full understanding before addressing concerns.
  • Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.
  • Interpreted and advised on labor relations policies and previously negotiated agreements.
  • Entered appeal requests in appeals module.
  • Provided outreach for additional information for appeals and grievances.
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Submitted verbal and written notification to members and providers.
  • Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
  • Prepared a variety of different written communications, reports and documents to ensure smooth operations.
  • Educated Job titles on contract procedures, administration and interpretation.
  • Provided expertise on all facets of Industry labor and employment law to help employers make more effective decisions.
08/2005 to 11/2016
Customer Service Representative III Health Net Of California City, STATE,
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Provided primary customer support to internal and external customers.
  • Fielded customer questions regarding available merchandise, sales, current prices and upcoming company changes.
  • Answered constant flow of customer calls with minimal wait times.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Cultivated customer loyalty, promoted repeat customers and improved sales.
  • Provided information regarding charge accounts and loyalty programs.
  • Recommended products to customers, thoroughly explaining details.
  • Collected customer feedback and made process changes to exceed customer satisfaction goals.
  • Communicated with vendors regarding backorder availability, future inventory and special orders.
  • Developed community reputation through commitment to customer satisfaction and strong client relationships.
  • Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
  • Evaluated account and service histories to identify trends, using data to mitigate future issues.
  • Responded to customer requests for products, services and company information.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Consulted with outside parties to resolve discrepancies and create effective solutions.
  • Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.
03/2005 to 05/2005
Medical Assistant Extern Capital Nephrology City, STATE,
  • Directed patients to exam rooms, fielded questions and prepared for physician examinations.
  • Assisted with routine checks and diagnostic testing by collecting and processing specimens.
  • Promoted office efficiency, coordinating charts, completing insurance forms and helping patients with diverse needs.
  • Supported duties for diagnostic and technical treatment procedures, such as setting up and operating special medical equipment and apparatus.
  • Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
  • Taught patients about medications, procedures and care plan instructions.
  • Ambulated, turned and positioned patients.
  • Obtained pre- and post-treatment vital signs and weight.
  • Tested and recorded blood glucose levels.
  • Documented vital signs and health history for patients in clinic and hospital environments.
  • Called and faxed pharmacies to submit prescriptions and refills.
  • Completed clinical procedures and gathered patient data for interpretation by physician.
  • Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment.
  • Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
  • Collected and documented patient medical information such as blood pressure and weight.
  • Obtained all prescribed laboratory testing.
  • Obtained client medical history, medication information, symptoms and allergies.
  • Performed clerical duties, such as word processing, data entry, answering phones and filing.
  • Verified appropriate lab couriers picked up collected lab specimens.
  • Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes.
  • Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed.
  • Prepared initial patient charts for admission.
  • Sanitized, restocked and organized exam rooms and medical equipment.
  • Monitored patients' response to dialysis therapy and reported any unusual findings to nurse supervisor.
Expected in 01/1991 to to
GED: General Studies
Charles A Jones Career And Education Center - 5451 Lemon Hill Ave, Sacramento, CA 95824,
Expected in 05/2005 to to
Medical Assistant: Medical Assisting
Maric College - Sacramento - Anaheim, CA
  • Medical Assistant Certification
  • August 2004 - May 2005

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Resume Overview

School Attended

  • Charles A Jones Career And Education Center
  • Maric College - Sacramento

Job Titles Held:

  • Appeals and Grievances
  • Customer Service Representative III
  • Medical Assistant Extern


  • GED
  • Medical Assistant

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