claims representative resume example with 14+ years of experience

Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,

Experienced in processing Property claims in high-volume environments. Successful at managing complete claims process with minimal direction. Conversational skills in English.

  • Relationship Management
  • Contract Negotiation Expertise
  • Contract Interpretation
  • Problem Resolution
  • Critical Thinking
  • Health Insurance Acumen
  • Claims Processing
  • Active Listening
  • System Diagnostics
  • Microsoft & Windows (Word, Excel &Power Point)
  • Account Development and Networking
  • Cost Control
  • Billing Discrepancy
  • Reviewing Data Quality
  • Conflict Management
  • Claims Resolution
  • Policy knowledge
  • Coverage determination
  • Documentation research
  • Accident review
  • Settlement agreements
  • Background in insurance
  • Insurance plan verification
  • Documentation skills
03/2022 to 06/2022 Claims Representative Do It Best Corp | Missoula, MT,
  • Verified details with policyholders and requested additional information.
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Presenting policy details to the client and signing the policy agreement.
  • Collecting premiums.
  • Processing client accounts.
  • Updating existing policies.
  • Documented specific claims by completing and recording forms, reports and logs.
06/2008 to 12/2021 Medical Billing/Provider Relation Grace To You Healthcare | City, STATE,
  • Assigned CPT procedure and evaluation and management (E&M) code for services to assure appropriate billing and reimbursement
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes
  • Evaluate and Negotiate contracts in compliance with client contract, Template reimbursement structure standards
  • Maintained professional relationships with healthcare providers
  • Cultivated strong relationships to maintain provider network knowledge and implement corrective actions for ongoing issues
  • Update provider data and document contracting activities
  • Stayed current on available policies and plans
  • Instructed providers on procedures and policy limitations for Traditional and Commercial plans
  • Provide feedback from prospective and newly contracted providers to the client
  • Improved profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
08/2007 to 05/2008 Analysts/Help Desk Technician J P Morgan Chase | City, STATE,
  • Served as a level-three support escalation point for 10-member distributed
  • Support staff
  • Processed an average of 70 inbound and outbound technical support calls
  • Resolved customer complaints and concerns by applying strong communication, conflict resolution, and negotiation skills
  • Researched, resolved, and followed up on Fraud and Dispute Claim customer issues, earning a 4-star customer review rating
  • Created new accounts, reset passwords and configured access to servers and file management software for users
  • Assisted customers with various types of technical issues via email, live chat and telephone
  • Researched, documented and escalated support cases to higher levels of support when unable to resolve issues using available resources
  • Responded to 50-200 individual tickets every week to provide end-user support on systems and software.
03/2007 to 07/2007 Customer Cards Service Specialist Washington Mutual | City, STATE,
  • Negotiated settlements and agreements between parties by providing mutual support and driving resolutions, Debt review and Credit Analysis
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations
  • Review and Process Dispute/Fraud claims to support (SLA) Service Level Agreement (Target 95%) (Performance 97%)
  • Documented customer correspondence in CRM to track requests, problems and solutions
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions
  • Explained benefits, features and recommendations to maximize client retention
  • Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks.
Education and Training
Expected in 06/2020 | Property & Casualty License Inspiring Tomorrow's Leaders, Dallas, TX, GPA:

Texas Property & Casualty License in Insurance

Expected in 02/2020 Adjuster License in Insurance | Texas All Lines Adjusters, Dallas, TX GPA:
Expected in 05/2019 Bachelor of Science | Computer Science University of Phoenix, Tempe, AZ GPA:
Expected in 03/2014 Tx Certificate of Completion in Information Technology Systems (CCNA) | Glade Technical, Dallas, GPA:

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Resume Overview

School Attended

  • Inspiring Tomorrow's Leaders
  • Texas All Lines Adjusters
  • University of Phoenix
  • Glade Technical

Job Titles Held:

  • Claims Representative
  • Medical Billing/Provider Relation
  • Analysts/Help Desk Technician
  • Customer Cards Service Specialist


  • Adjuster License in Insurance
  • Bachelor of Science
  • Tx Certificate of Completion in Information Technology Systems (CCNA)

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