Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Career Overview
  • Highly enthusiastic customer service professional with 15  years client interface experience.
  • Enthusiastic customer service/telesales representative with in-depth knowledge of sales, account management and training.
  • Energetic and reliable customer service representative
  • Dedicated Customer Service Representative motivated to maintain customer satisfaction and contribute to company success.
  • Customer Service Representative with extensive knowledge of the health care  business. Energetic, outgoing and driven to reach company goals.
  • Accurate Customer service Representative versed in database management. Strong organizational, technical and analytical skills.
  • Highly effective at handling confidential information and identifying system improvements with ease.
  • Customer Service Representative who successfully manages multiple data entry projects at once. Transcription expert focused on delivering high quality results in a timely manner.
Core Strengths
  • Time management
  • Microsoft Office proficiency
  • Self-directed
  • Excellent communication skills
  • Computer-savvy
  • Strong problem solver
  • Resourceful
  • Strong interpersonal skills
  • Pleasant demeanor
  • Customer service-oriented
  • Critical thinker
  • Claims appeal procedures
  • HIPAA compliance
  • High customer service standards
  • Service solutions expert
  • Call center management experience

  • Training manual contributor
  • Proficient with Microsoft Outlook, Excel & PowerPoint, Access, Lotus Notes, Great Plains, Siebel, Linx, Cosmos, Iset, Facets, NDB,
  • Strong organizational skills  
  • Courteous demeanor
  • Energetic work attitude
  • Customer service expert
  • Adaptive team player
  • Troubleshooting skills
  • Strong problem solving ability
  • Devoted to data integrity
  • Conflict resolution proficiency
  • Dedicated to process improvement

Customer Service

  • Researched, calmed and rapidly resolved client/provider conflicts to prevent escalated calls
  • Managed call flow.

  • Investigated any necessary information for proper billing for, patients and providers such as proper billing codes.
  • Researched and resolved billing problems


  • Consistently generated additional revenue through skilled sales techniques.

Received 3 Bravo awards from current Manager and Regional Vice President of Claims

Work Experience
06/2014 to Current Claims Customer Service Rep American Modern Insurance Group | Flagler Beach, FL,

Paula Decker XXX.205.2802

  • Respond to and resolve customer service inquires on the first call
  • Assist customers & providers in navigating UnitedHealth Group websites 
  • Research complex issues using  multiple databases 
  • Submit pre-authorizations or pre-determination requests
  • Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
  • Ensure that claims are processed and audit for accuracy
  • Provide solutions for outstanding claims
  • Investigate issues and document steps taken to achieve resolution
  • Investigate and handle retro-certification activities, as required for resolution of customer issues
  • Respond to customers regarding status of formal complaints or appeals
  • Escalate issues to Senior Customer Service Reps when appropriate
  • Meet departmental standards for production and quality
  • Basic knowledge of managed healthcare and claims
  • Provide expertise claims support for all related aspects of claim system processes and claim business rule
  • Responsible for reviewing, researching, investigating and adjusting claims
  • Understand claims payment for Commercial and Medicare/Medicaid business

06/2013 to 05/2014 ISR - Inside Sales Representative Highmark Inc. | Warrendale, PA,

Marlene Zaback  XXX.205.11 50

  • Provide excellent customer service and product support in assisting with the process and selection of high quality premium hearing devices.
  • Meet established productivity, schedule adherence, and quality standards
  • Respond to complex customer calls regarding the use, maintenance and repair of hearing devices
  • Effectively listen and respond to customer questions and challenges in order to provide the best possible product choices and order placement channels.
  • Strong consultative skills to promote features and benefits of the different hearing devices available
  • Provide order entry, payment collection and communication of FDA requirements
  • Provide outbound calls to provide product recommendations and complete the order
  • Provide education to first time users on wearing and maintaining the hearing devices.
  • Assist with technical difficulties with the website.

2012 to 06/2013 Claims Processor Driasi - Direct Response Insurance Administrator Service Inc. | City, STATE,

Julie Loftius XXX.556.8283

  • Request Applications, enrollment forms for claim submitted
  • Review Enrollment forms for correct Beneficiary/s
  • Fill-lout claim form with deceased name and beneficiary info
  • Send the claim forms out to Informants or Beneficiaries
  • Build Claim in USSI (United Systems Software Inc.)
  • Run follow-up report weekly
  • Send out follow up claim forms -Assist with Special projects
  • Maintain a log for daily loss reports and backlog 

Educational Background
Expected in 1995 | South Central Technical College, , GPA:
Expected in 1993 HS Diploma | St. James High School, , GPA:
  • Customer Service
  • Critical Thinking
  • Telephone Skills
  • Time Management
  • Professional and friendly
  • Multi-tasking
  • Prioritization
  • Attention to detail

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School Attended

  • South Central Technical College
  • St. James High School

Job Titles Held:

  • Claims Customer Service Rep
  • ISR - Inside Sales Representative
  • Claims Processor


  • HS Diploma

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