Claims Specialist resume example with 12+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - - -
Professional Summary

10+ years of experience providing customer support in all areas. An unwavering commitment to customer service with the ability to build productive relationships, resolve complex issues and win customer loyalty. Strategic- relationship/partnership building skills-listen attentively, solve problems creatively, and use tact diplomacy to find common ground and achieve win-win outcomes.

  • Microsoft Word, Outlook, Excel, PowerPoint, Usage of Internet Explorer
  • Superior Interpersonal and Good oral knowledge of Medical Terminology
  • Profound understanding of Customer Psychology
  • MS Office Experience and excellent typing skills (30-40 WPM)
  • EPIC Certified
  • Clerical
  • Insurance billing
  • Insurance verifying
  • Medicaid management information systems
  • Telecommunications
  • Problem solver
  • Payment processing
  • Payment collection
  • Insurance Knowledge
  • Coverage assessments
Work History
01/2020 to Current
Claims Specialist Gila River Health Care Sacaton, AZ,
  • COP (Claims Owner Processor) for the Catastrophe Unit that assists with severe weather by deploying catastrophe claim personnel and establishing scheduled appointments for customers with extreme extensive to moderate damage
  • Xactimate certified (XactAnalysis)
  • 54 Storm/ Providing policy holders 24/7 claims service: Express access, Hurricane preparation, FEMA, Flood and Auto inquiries
  • Perform clerical duties, including: data entry, filing paper documents, email, calendar management, and word processing
  • Handle claim files (locate/request files, file paperwork, re-construct missing files, move misfiled documents, send to other offices, etc) Retrieve, print, fax, or mail supporting documentation to vendors or others as directed
  • Provide back up for any support functions in the office
  • Investigate prior losses and other information on file and order reports as needed at the direction of adjusters and management
  • Receive, screen and route incoming telephone calls and other electronic correspondence
  • Contact or receive contact from customers or other claims related third parties to obtain and or provide necessary file information to comply with quality and process standards Generate and send appropriate forms to insured/claimant for completion
  • Process claim payments
  • Complete all necessary forms, logs-documents into the system, and route them to the appropriate parties
  • Assist adjusters with more complex claim handling, analyze documentation and settle basic straight-forward and routine claims quickly and efficiently
01/2019 to 01/2020
ED/Admitting Services Registrar Aveanna Healthcare Austin, MN,
  • Obtained all demographic and financial information by interviewing families face-to-face to create and complete the registration process. Accurately created and updated registration data for patients
    Prompted patients for front-end collections payments and reconciling payments via Epic
    Verified benefit coverage and eligibility via on-line resources, fax, or telephone
    Initiated and completed the pre-certification process including the forwarding of any supportive clinical documentation.
    Calculated and validated estimates for patient balances and identified patient requiring financial assistance (PFA)
    Guided patients through the financial assistance process, assisted with payment plans, and applying for state insurance.
    Assisted patients with understanding their bill and financial obligations
    Documented all encounters in Epic account notes.
    Performed other related duties as assigned
    Maintained knowledge of managed care/insurance requirements by attending educational sessions
11/2016 to 02/2018
Patient Access Representative Northshore University Health Systems City, STATE,
  • Highly experienced in facilitating communication between patients, family members and medical staff to ensure positive outcomes
  • Qualified to communicate with referring providers' offices and clerical departments to exchange necessary information and determine schedules
  • Demonstrated expertise in interviewing patients or caregivers to identify issues related to care and medical services
  • Proficient in determining the right type of health care services for each patient and referring them to appropriate healthcare resources
  • Adept at verifying insurance benefits and obtaining pre-certifications along with determining co-pays and deductibles
  • Well-versed in gathering and posting patient demographic, billing and clinical information and accurately entering it into hospital registration systems
  • Proven record of efficiently completing patient access processes for both inpatient and outpatient departments
  • Track record of effectively communicating payment options and personally connecting patients to financial counselors
  • First-hand experience in prioritizing the order of care to ensure that critical patients are seen first
11/2008 to 09/2016
Shift Lead/ Key Holder Au Bon Pain City, STATE,
  • Front-line Customer Service Representative that was responsible for ensuring a total customer experience to include: excellent product preparation and knowledge; fast, friendly and accurate customer service; maintenance of product merchandising, a clean and safe cafe
  • Courteously greet customers and efficiently process transactions within the busy, fast paced retail environment
  • Assist with store stocking, floor-sets and opening/closing procedures
Expected in 06/2024
Associate of Arts: Business Administration And Management
Triton College - River Grove, IL
  • Continuing education in Real Estate
  • CHICAGO Association of Realtors (Real Estate School)
  • Officially commended for enthusiasm, tenacity, persuasiveness, intense customer focus and dependability inperformance evaluations
  • Completed voluntary customer service training to learn ways to enhance customersatisfaction and improve productivity
  • The Customer Service Institute of America-2014

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Resume Overview

School Attended

  • Triton College

Job Titles Held:

  • Claims Specialist
  • ED/Admitting Services Registrar
  • Patient Access Representative
  • Shift Lead/ Key Holder


  • Associate of Arts

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