claims specialist resume example with 12+ years of experience

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

Detailed Representative with demonstrated commitment to organization, service and professionalism. Excellent computer and communication skills with exceptional knowledge of Customer Service , Hardware, and Networking functions. 60 wpm type speed with 100% accuracy combined with proficiency in Software.

  • Software applications
  • Good listening skills
  • Leadership
  • Critical thinking
  • MS Office
  • Hardware knowledge
Work History
04/2020 to 08/2021
Claims Specialist Naphcare Henderson, NV,
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Processed and recorded new policies and claims.
  • Notified insurance agents and accounting departments of policy cancellations and changes.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Calculated adjustments, premiums, and refunds.
  • Implemented improvements in manual and electronic billing procedures.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

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  • Addressed average of Number customer inquiries and complaints each week.
08/2010 to 08/2020
Customer Service Manager Gold's Gym International, Inc. Kennewick, WA,
  • Developed documentation and logs of implemented solutions and generated and submitted reports.
  • Aided senior leadership during executive decision-making processes and generated daily reports to recommend corrective actions and improvements.
  • Consistently managed Number-person staff, effectively resolving issues, which resulted in top ranking out of Number teams.

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  • Collected customer feedback and made process changes to exceed customer satisfaction goals.
  • Coordinated resolutions for more than Number daily customer inquiries while consistently achieving performance targets.
  • Collaborated with Job title to improve customer service processes and support structures company-wide.
  • Provided Tier 1 IT support to non-technical internal users through desk side support services.
  • Assisted customers in identifying issues and explained solutions to restore service and functionality.
  • Conducted in-depth product and issue resolution research to address customer concerns.
  • Loaded software, granted permissions and configured hardware for new employees as part of onboarding process.
  • Integrated Salesforce CRM and other customer relationship management software into support operations.
  • Collaborated with Job titles in disaster planning, network backup and recovery process monitoring.
  • Wrote ad hoc tools and patches to resolve recurring production problems.
  • Performed code review, code optimization, SQL query optimization and performance improvement for servers.
  • Created inventory, report and invoicing databases.
  • Configured and installed wireless controllers, routers and switches.
  • Monitored Number company-wide trouble ticket queues.
  • Diagnosed system hardware and software problems using advanced root-cause analysis.
  • Completed remote repairs involving software solutions and hardware repairs.
  • Worked extensively with Software name to schedule and store reports.
  • Served as liaison between user community and software providers.
  • Communicated with vendors to resolve network outages and periods of reduced performance.
  • Kept up-to-date on new developments in computer and network vulnerabilities, data hiding and encryption.
  • Created help desk tickets, troubleshot and resolved desktop issues.
  • Determined hardware and network system issues using proactive troubleshooting techniques.
  • Responded to faults in both LAN and WAN networks to rapidly restore connectivity and prevent unnecessary downtimes.
  • Resolved system, hardware and telephone issues within Number hours, improving efficiency among departments.
  • Offered troubleshooting of connectivity issues across networks such as Wi-Fi, cellular and Type.
11/2008 to 06/2010
Flight Attendant Mesa Air Group Cincinnati, OH,
  • Used critical thinking to break down problems, evaluate solutions and make decisions.
  • Ensure safety and comfort of customers onboard aircraft.
  • Ensured aircraft and passenger compliance with policies, procedures, regulations and safety guidance.
  • Answered passengers' questions and provided solutions to issues arising during flights.
  • Clearly explained and demonstrated safety and emergency procedures to passengers prior to takeoff.
  • Attended workshops and trainings in customer service, conflict resolution tactics and safety procedures to keep abreast of all new requirements and procedures.
  • Served beverages and food items from refreshment cart and provided information about in-flight offerings to passengers.

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  • Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
  • Participated in team-building activities to enhance working relationships.
  • Facilitated boarding process by greeting passengers upon arrival to aircraft and providing direction to seats.
  • Greeted passengers, assisted with carry-on baggage stowage, and delivered onboard announcements.
  • Facilitated communication between flight deck and cabin crew prior to and during flights to promote smooth operations.
  • Resolved passenger situations during flight involving disorderly passengers and medical emergencies.
  • Drove passenger satisfaction by answering questions and providing solutions to issues arising during flights promptly.
Expected in 02/2022 to to
Associate Of Business Administration: Business Administration
Atlanta Technical College - Atlanta, GA

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Resume Overview

School Attended

  • Atlanta Technical College

Job Titles Held:

  • Claims Specialist
  • Customer Service Manager
  • Flight Attendant


  • Associate Of Business Administration

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