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claims specialist resume example with 4+ years of experience

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

Well-trained Claims and Customer Service Advocate with over 13 years of experience helping others. Ambitious, career-focused job seeker, anxious to obtain an entry-level Claim Specialist position to help launch career while achieving company goals.

Skills
  • Personal service background
  • Decision-making skills
  • HIPAA guidelines
  • Microsoft Office proficiency
  • Insurance Claim Forms Review
  • Customer Service
  • Teamwork and Collaboration
  • Data Entry
  • Critical Thinking
  • Data Entry Software
  • Attention to Detail
Experience
03/2023 to Current
Claims Specialist Newell Brands Wichita, KS,
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Communicated with other departments to establish action plans and manage open claims to closure.
  • Planned and conducted investigations of claims to confirm coverage and compensability.
  • Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
  • Identified and obtained evidence to ascertain claim value.
  • Investigated questionable claims to determine payment authorization.
  • Reviewed data to verify validity of claims and determine case management actions.
05/2022 to 03/2023
Service Advocate Cvs Health Corpus Christi, TX,
  • Review a member's enrollment or claims history including all debits and credits and claims detail level at the member level for a multi-year period ensuring accuracy of billing and enrollment and application of deductible and member responsibility.
  • Utilize the Florida Blue Call Strategy to provide outstanding customer service and call resolution to our members; follow-up on issues to ensure resolution for customer.
  • Evaluate data through questioning, probing, and reasoning for process improvements.
  • Research and resolve sales and service-related inquiries for all lines of business, health and ancillary products, meeting established expectations for quality, productivity and timeliness.
  • Built customer loyalty and strength by finding solutions to customers needs.
  • Verified claim data correctness in preparation for processing.
  • Researched medical claims for validity to resolve discrepancies.
  • Reviewed history records to determine benefit eligibility for services.
02/2020 to 04/2021
Municipal Clerk Springhill Township City, STATE,
  • Established and maintained variety of automated and manual files and records.
  • Assisted with clerical duties at city hall by performing copying, scanning, faxing and data entry tasks and scheduling appointments.
  • Prepared reports, correspondence, executive summaries, agenda and agenda packet materials and processed mail and routed correspondence to correct office or department.
  • Assisted in preparing ordinances and resolutions proposed by governing body for approval, notified legal organization of meetings, dates and times and distributed communications to appropriate parties.
  • Supported municipal operations by processing financial transactions, reconciling vendor invoices, delivering on-call clerical support to district offices and assisting with month-end accounting.
  • Prepared and maintained township accounting documents and records, entered financial transactions into database, reconciled transactions promptly and administered billing and invoices.
  • Aided City Clerk by tracking and organizing projects, reviewing and reconciling bill-of-lading discrepancies and maintaining office files and spreadsheets.
  • Typed and proofread correspondence, distributed and filed official forms and scheduled appointments.
  • Prepared ordinances, resolutions and proclamations to be executed, recorded, archived and distributed.
  • Served as notary public and issued various permits and licenses.
  • Received and submitted payments for fees and fines, accurately tracking amounts, issuing receipts and updating computer systems.
09/2017 to 12/2019
REHABILITATION ADMINISTRATIVE ASSISTANT/Therapy Assistant Functional Pathways LLC. City, STATE,
  • Developed administrative processes to achieve organizational objectives and improve office efficiency.
  • Managed physical and digital files, monitored spreadsheets and updated reports to coordinate project materials.
  • Directed customer communication to appropriate department personnel.
  • Tracked and submitted employee timesheets to prepare for payroll processing.
  • Coordinated appointments, meetings and conferences.
  • Scheduled appointments, meetings and events for management staff.
  • Provided secretarial and office management support while building cooperative working relationships.
  • Prepared and prioritized calendars and correspondence.
  • Utilized editing programs to proofread content for typo-free emails, memos and documentation.
  • Responded effectively to sensitive inquiries or complaints.
  • Composed correspondence, reports and meeting notes.
  • Maintained accurate department and customer records.
  • Inventoried and ordered supplies for office.
  • Answered phone calls and emails to provide information, resulting in effective business correspondence.
  • Managed office duties, ordered materials, organized workspaces, answered emails and made phone calls.
  • Answered phones to direct callers, schedule appointments and provide general office information.
  • Greeted visitors or callers to handle questions or direct to appropriate staff.
  • Received and routed incoming calls and correspondence to promote timely communication.
Education and Training
Expected in 06/2004 to to
High School Diploma:
Albert Gallatin Area Senior High School - Uniontown, PA
GPA:

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Resume Overview

School Attended

  • Albert Gallatin Area Senior High School

Job Titles Held:

  • Claims Specialist
  • Service Advocate
  • Municipal Clerk
  • REHABILITATION ADMINISTRATIVE ASSISTANT/Therapy Assistant

Degrees

  • High School Diploma

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