claims representative resume example with 13+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
Professional Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 15 years of customer service experience.
Skills
- Experience with governmental agencies
- Proficient in Microsoft programs and Google documents, Adobe and Visio
- Flexible and Adaptable
- Decision-Making
- Multitasking Abilities
- Planning and Coordination
- Self-Motivated
- Analytical and Critical Thinking
- Natural hard worker
- Strong in quality assurance for all clients
- Experience with administrative duties
- Experience with data analysis
Education
DSS Sacramento, CA, Expected in 05/2023 ā ā No Degree : Home Health Care Aide - :
Home Health Aide Register
Per ID# 7510003104
Asher College Sacramento, CA Expected in 09/2020 ā ā Pharmacy License : Pharmacy Technology - :
GPA: 4.0 TCH#180360
Carrington College California - Sacramento Sacramento, CA Expected in 11/2010 ā ā Associate of Science : Health Administration - :
GPA: 3.7
Work History
Genex Services - IHSS Care Provider
, , Sacramento, CA 10/2008 - Current
, , Sacramento, CA 10/2008 - Current
- Provided transportation and appointments management.
- Assisted disabled clients to support independence and well-being.
- Assisted patients with dressing, grooming and feeding needs, helping to overcome and adapt to mobility restrictions.
- Traveled to clients' homes to complete healthcare services and promote continuity of care.
- Administered medication as directed by physician.
- Completed medical and program reports and maintained records following clinic standard operating procedures.
- Reported unusual or urgent circumstances in patients' condition or environment immediately to nurse supervisor.
- Completed entries in log books, journals and care plans to accurately document and report patient progress.
- Assisted clients with daily living needs to maintain self-esteem and general wellness.
- Monitored clients' overall health and well-being and noted significant changes.
- Planned healthy meals, purchased ingredients and cooked meals to provide adequate nutrition for client wellbeing.
- Recorded patients' pulse, blood pressure and respirations (TPRs) to assess and document important health information.
Accentcare - Claims Representative
, , Sacramento, CA 10/2021 - 02/2023
, , Sacramento, CA 10/2021 - 02/2023
- Make outbound calls to EDD customers regarding claims
- Documenting personal information for EDD UI claim processing
- Analyzing EDD UI claim information to identify discrepancies or missing information
- Assessing EDD UI information against requirements based on UI Code, Policies, and Procedures
- Maintained confidentiality of patient finances, records and health statuses.
- Remote work with specified equipment for efficient/accurate processing
- EDD UI Case management efficiency
- Train members of team for efficient/accurate outcomes
- Worked productively in fast-moving work environment to process large volumes of EDD UI claims.
- Generated, posted and attached information to claim files.
- Examined EDD UI reports, accounts and evidence to determine integrity and accuracy of information.
- Modeled exceptional customer service skills and appropriate techniques to team members.
- Processed and recorded new EDD UI policies and claims.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients, and creating documents for EDD UI.
Amita Health - Call Center Representative
, , Roseville, CA 07/2020 - 08/2021
, , Roseville, CA 07/2020 - 08/2021
- Adhered to company policies and scripts to consistently achieve call-time and quality standards.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Learned and maintained in-depth understanding of product information, providing knowledgeable responses to diverse questions.
- Educated customers on company systems, form completion and access to services.
- Met customer call guidelines for service levels, handle time and productivity.
- Maintained up-to-date knowledge of product and service changes.
- Promptly responded to inquiries and requests from prospective customers.
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Resume Overview
School Attended
- DSS
- Asher College
- Carrington College California - Sacramento
Job Titles Held:
- IHSS Care Provider
- Claims Representative
- Call Center Representative
Degrees
- No Degree
- Pharmacy License
- Associate of Science
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