Claims Specialist resume example with 12+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
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.
Skills
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 SpecialistGila 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
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 RepresentativeNorthshore 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 HolderAu 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
Education
Expected in 06/2024
Associate of Arts: Business Administration And Management Triton College - River Grove, IL GPA:
Continuing education in Real Estate
CHICAGO Association of Realtors (Real Estate School)
Accomplishments
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
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