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business process specialist resume example with 20+ years of experience

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

Ambitious, highly qualified bilingual customer service professional with strong customer relations skills and extensive experience in a fast paced work environment with a history of increasing responsibilities.

Skills
  • Customer Service
  • Call Center Operations
  • Inbound and outbound Calling
  • Courteous Demeanor
  • Efficient and Detail-Oriented
  • Multitasking and Prioritization
  • Microsoft Office
  • Conflict Resolution
  • Account Posting
  • Billing Data Verification
  • Billing and Invoicing
  • Verbal and Written Communication
  • Account Reviews
  • Data Entry Expertise
  • Relationship Building
  • Invoicing Proficiency
  • Itemized Statement Preparation
  • Account Management
  • Problem-Solving
  • Billing Issue Resolution and Support
  • Medical Terminology
  • Account Servicing
  • Credit Card Payment Processing
  • Issue and Complaint Resolution
  • Calm and Professional Under Pressure
Experience
Business Process Specialist, 07/2022 to Current
RtxIdledale, CO,
  • Liaison to the individual business areas withing the organization evaluating, planning and implementing improvements
  • Served as primary interface between stakeholders and IT Department, communicating proposed implementations of new systems and current system upgrades.
  • Investigated and resolved Billing problems with self-motivated and knowledgeable approach based on sound understanding of failure analysis and statistical methodology.
  • Collected and analyzed user stories and leveraged data to enhance and expand future process planning and solution strategies.
  • Worked directly with clients to accurately define nebulous business requirements, designing operational frameworks suited to each customer's requirements.
Policyholder Service Specialist, 02/2009 to 07/2022
CarenationalPortland, ME,
  • Responded promptly to customers' concerns and coordinated swift resolutions to handle service issues.
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
  • Answered inbound calls, chats and emails to facilitate customer service. Handled high volume calls each day.
  • Demonstrated excellent communication skills in resolving product and consumer complaints.
  • Used proven techniques to de-escalate angry customers during telephone interactions.
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Assisted customers with making payments or establishing payment plans to bring accounts current.
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
  • Set up and activated customer accounts.
  • Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
  • Conducted testing of forms, rates, invoices, website, worked close with the Project manager, and Developers
  • Educated customers to facilitate online invoices and payment remittances.
  • Provided input to policies and systems, optimizing premium billing function.
Senior Provider Relations Coordinator, 01/2003 to 11/2008
Conduent IncorporatedIrving, TX,
  • Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues.
  • Investigated concerns such as billing and claims questions on behalf of providers.
  • Stayed current on available policies and plans.
  • Enhanced client satisfaction ratings by resolving disputes and partnering with healthcare providers to clarify issues.
  • Explained policies, procedures and services to Hospital and Medical groups, during site visits.
  • Collaborated with clinical and administrative staff to meet patient needs.
Utilization Review Assistant, 01/1999 to 2003
One Health Plan Of IllinoisCity, STATE,
  • Determined medical necessity and cost-effectiveness of services through utilization review processes.
  • Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
  • Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
  • Kept detailed documentation on all utilization reviews by accurately documenting the patients file.
  • Protected medical information against unauthorized access, loss or corruption by consistently following security protocols.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Handled high volume calls each day
Education and Training
Associates: Applied Science, Business Administration, Expected in 01/1999 to Robert Morris College, National Education Center - Chicago, Illinois
GPA:
Diploma: , Expected in 01/1992 to Carl Schurz High School - Chicago, Illinois
GPA:
Certifications
  • Licensed Property and Casualty - January 2021
,

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Resume Overview

School Attended

  • Robert Morris College, National Education Center
  • Carl Schurz High School

Job Titles Held:

  • Business Process Specialist
  • Policyholder Service Specialist
  • Senior Provider Relations Coordinator
  • Utilization Review Assistant

Degrees

  • Associates
  • Diploma

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