Claims Processor resume example with 4+ years of experience

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

Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality.

  • Policy Modifications and Updates
  • Insurance Claim Forms Review
  • Informational Releases
  • Coverage Determination
  • Insurance Carrier Applications
  • Office Operations
  • Financial Assistance
  • Transactions Reconciliation
  • New Policies Processing
  • Small Claims Payouts
  • Claim Amount Calculations
  • Premium Collection
  • Eligibility Determinations
  • Customer Feedback
  • Validation of Discrepancies
  • Past Due Balance Management
  • Accounts Payable and Accounts Receivable
  • Payments Posting
  • Prescription Refills
  • Account Management Software
  • Information Updates
  • Industry Trends
  • Constructive Feedback
  • Cost Savings
  • High-Volume Environments
  • Communications Strategies
  • Training Junior Team Members
  • Client Correspondence
  • Reading Comprehension
  • Cold Calling
  • Direct Marketing
  • Prospecting Clients
  • Spreadsheet Tracking
  • Team Meetings
  • Filing Appeals
  • Customer Relationship Management
  • Claims Investigations
  • Patient Admission
  • Casualty Insurance Industry Knowledge
  • Customer Retention
  • Purchase Orders
  • Digital Filing
  • Creative Solutions
  • System Updates
  • Legal Standards
  • Client Satisfaction
  • Client Rapport-Building
  • Account Changes
  • Data Communications
  • Office Organization
  • Status Updates
  • Data Integrity
  • Professional Development
  • Staff Support
  • Project Requirements
  • Office Supplies and Inventory
  • Call Control
  • Work Organizing and Prioritizing
  • Policy Reinstatement Approvals
  • Billing Software
  • Data Entry Software
  • Regulatory Compliance Adherence
  • Policy and Procedure Explanations
  • Payment and Investigation Escalations
  • Cancellation Notifications
  • Understanding Customer Needs
  • Data Entry and Maintenance
  • Customer Retention Strategies
  • Efficient and Detail-Oriented
  • Call Documentation
  • Upselling Products and Services
  • Needs Assessment
  • Building Customer Trust and Loyalty
  • Calm and Professional Under Pressure
  • Responding to Difficult Customers
  • Issue and Complaint Resolution
  • Electronic Information Systems
  • Customer Inquiry Response
  • 10-Key Certification
  • Standard Operating Procedures Maintenance
  • Data Compilation
  • Data Review
  • Data Verification
  • Transcribing Documents
  • Efficient Data Entry
  • Critical Thinking
Work History
12/2021 to 09/2022
Claims Processor Lowe's Companies, Inc. Gilbert, AZ,
  • Evaluated accuracy and quality of data entered into agency management system.
  • Followed up with customers on unresolved issues.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
  • Analyzed information gathered by investigations to report findings and recommendations.
  • Investigated properties to determine extent of damage and estimate repair costs.
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Modeled exceptional customer service skills and appropriate diagnostic sales techniques to team members.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
  • Checked documentation for accuracy and validity on updated systems.
  • Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
  • Generated, posted and attached information to claim files.
  • Verified client information by analyzing existing evidence on file.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Processed and recorded new policies and claims.
  • Posted payments to accounts and maintained records.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Modified, updated and processed existing policies.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Calculated adjustments, premiums, and refunds.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Coordinated with contracting department to resolve payer issues.
  • Determined appropriateness of payers to protect organization and minimize risk.
01/2021 to 12/2021
Benefit Verification Specialist Jordan Valley Community Health Center Hollister, MO,
  • Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
  • Checked employees' benefits enrollment for accuracy and inputted all data.
  • Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email and in-person interactions.
  • Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.
  • Observed strict procedures to maintain data and plan participant confidentiality.
  • Coordinated submission and processing of life insurance claims.
  • Processed monthly remittance and reconciliation for various benefit plans.
  • Directed and controlled 401K, medical, dental and vision benefit packages.
  • Updated benefit cost summaries for employer cost tracking.
  • Developed and oversaw incentive plans, stock options, corporate credit cards and compensation policies determined by financial analysis.
  • Updated personnel handbooks and individual records to keep filed accurate and detailed.
  • Researched job and worker requirements, occupational trends and structural and functional relationships among jobs and occupations.
  • Delivered targeted advise on issues such as applicable employment regulations, compensation strategies and internal systems to help companies update antiquated or ineffective approaches.
  • Advised managers and employees on state and federal employment regulations, collective agreements and classification programs.
  • Gathered information about each position and related occupation with employee interviews, field observations and industry research.
  • Performed multifactor data and cost analyses for use in areas such as support of collective bargaining agreements.
  • Organized positions by factors such as salary and status to develop effective categories and operational strategies.
  • Created current job descriptions to underpin consistent, market-based systems.
11/2019 to 01/2021
Technical Support Representative Trimble Smithville, MO,
  • Assisted customers in identifying issues and explained solutions to restore service and functionality.
  • Resolved diverse range of technical issues across multiple systems and applications for customers and end-users across various time zones.
  • Collaborated with supervisors to escalate and address customer inquiries or technical issues.
  • Translated complex technical issues into digestible language for non-technical users.
  • Provided Tier 1 IT support to non-technical internal users through desk side support services.
  • Submitted service tickets for equipment maintenance requests.
  • Used ticketing systems to manage and process support actions and requests.
  • Documented transactions and support interactions in system for future reference and addition to knowledge base.
  • Assisted customers with product selection based on stated needs, proposed use and budget.
  • Conducted in-depth product and issue resolution research to address customer concerns.
  • Resolved escalated issues by serving as subject matter expert on wide-ranging issues.
  • Activated accounts for clients interested in new services.
  • Provided documentation on start-up, shut down and first-level troubleshooting of technical processes to support desk staff.
  • Wrote and reviewed tickets to request maintenance to various types of equipment.
  • Identified potential sales and cross-selling opportunities in course of delivery of support services.
  • Evaluated and responded to incoming sales leads and requests for technical support assistance.
  • Built and maintained internal knowledge bases for support products to expand available feedback and performance data.
  • Monitored systems in operation and input commands to troubleshoot areas.
  • Collaborated with colleagues in both domestic and international support facilities.
  • Provided replacement files to customers missing data, media files, and software components.
  • Provided support for networking protocols and characteristics.
  • Integrated Salesforce CRM and other customer relationship management software into support operations.
  • Loaded software, granted permissions and configured hardware for new employees as part of onboarding process.
  • Maintained familiarity with API and authentication mechanisms for supported products.
02/2018 to 11/2019
Customer Service Representative Cosentino's Food Stores City, State,
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Answered constant flow of customer calls with minimal wait times.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Responded to customer requests for products, services and company information.
  • Provided primary customer support to internal and external customers.
  • Recommended products to customers, thoroughly explaining details.
  • Assisted customers with setting appointments, special order requests, and arranging merchandise pick-up.
  • Collected customer feedback and made process changes to exceed customer satisfaction goals.
Expected in 05/2023
Bachelor of Science: Business Administration And Management
Pearl River Community College - Poplarville, MS
Expected in 05/2017
High School Diploma:
Laurel High School - Laurel, MS
  • Dean's List (2016 & 2017)
  • 3.0 GPA
  • Ranked in Top 10% of class

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Pearl River Community College
  • Laurel High School

Job Titles Held:

  • Claims Processor
  • Benefit Verification Specialist
  • Technical Support Representative
  • Customer Service Representative


  • Bachelor of Science
  • High School Diploma

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: