Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
Over 15 years' experience in customer service, billing, and claims production management, including development of policies and procedures, delivery of training and effectively managing projects.

  • Supervision & Sales
  • Excellent problem solving skills
  • Ability to analyze and understand market data
  • Ability to develop, present, and execute customer plans with a focus on customer communication and account penetration *Great Customer Service
  • Strong understanding of retail operation and negotiation skills and trade strategy
  • Leading sales efforts
  • Medicare/Medicaid Insurance Practices
  • Good Verbal & Written Communication Skills *Able to adapt to changing priorities
  • Resourceful & Flexible *Organizational & Time Management Skills
  • Maintain Positive Attitude *Strong Work Ethic Microsoft Office Suite, Advantage, Lotus Notes, Access, PowerPoint, Excel
  • Desktop Publishing, Windows 9x, XT, XP, Crystal Reports, Platforms
  • IT Help Desk, ICD-9 Translator, Data Entry
  • Multi-Line Telephone Software/Hardware
  • Data Entry
  • Medical Claims
  • Claims Adjustment
Established good working relationships with customers/clients. Identified and utilized varieties of learning materials, resources and technology methods such as team learning, internet learning to support and improve the instructional environment.
Client Services Representative, 09/2015 to Current
Internet Brands, Inc.North Adams, MA,
  • Demonstrates helpful and effective telephone etiquette and customer service skills by providing appropriate information to callers.
  • Ability to accurately and efficiently utilize a computer for data input, retrieval of data and all other tasks associated with release of information services and time reporting.
  • Researches, troubleshoots and resolves customer/client problems Validates requests and authorizations for release of medical information according to established procedures and HIPAA guidelines.
Healthcare Claims Specialist, 11/2014 to 08/2015
Bioplus Specialty PharmacyLongwood (Ahre), FL,
  • Processed adjudication of complex claims, including hospital claims, Coordination of Benefits, Co-surgeons, multiple surgical procedures, dual entitled members, adjustments, workers' Compensations or motor vehicle accidents Utilized claims processing experience and working knowledge of Medicare and Medicaid to effectively and efficiently process claims Responsible for reviewing inpatient and outpatient claims for accuracy and completeness, Experience with claims submission/billing software systems.
Front End Billing Supervisor, 04/2012 to 11/2014
Panera Bread CoApple Valley, MN,
  • Accomplished human resource objectives by selecting, assigning, scheduling, training, orienting, planning, adhering to policies and procedures Supervise employees; maintain employee work/PLB schedules; evaluate and manage employee performance, communicate expectations and goals, disciplinary actions and/or improvement plans, perform quarterly appraisals and reviews Determine departmental staffing needs; interview and evaluate candidates Leads weekly team meetings; attend and participate in interdepartmental meetings as requested Partner with training coordinator to ensure departmental training needs are met Create and update Standard Operating Procedures (SOP's); ensure employee compliance Ensure that production, performances, sample issues and volumes are within established guidelines by monitoring reports Assist department manager with delegating and assigning projects Assist department manager with establishing department rules, procedures, standards and improvements; work with manager to resolve employee grievances in accordance with organizational policy Assist department manager in meeting department objectives and goals Build strong interdepartmental relationships/partnerships.
Administrative Team Lead Medical Billing Specialist/Coder, 10/2009 to 04/2012
Mcdonald'sEllenwood, GA,
  • Worked daily electronic and manual billing files and submitted insurance claims to third party payors, including Medicare, Medicaid, and private insurance Experience with claims submission/billing software systems Performed posting of patient information at the set production level, while maintaining a 97% quality rate; worked billing exceptions report in an electronic format by utilizing the system tools for resolution or phone calls to the customer for needed billing information, and updated accordingly Identified trends and ways to help prevent billing exceptions and notify management Followed policies with HIPPA and other agencies ICD-9 Translator, translated medical terms into ICD-9 format.
Manager, 01/2011 to 04/2012
Rue21City, STATE,
  • Handled merchandising, supervised and inspired employees, opened and closed store, prepared daily sales reports and bank deposits Provided administration and control of financial transactions and sales in the retail environment Supervised all customer services, displayed merchandise, maintenance and employee training Assisted with hiring and firing of all employees Managed controllable expenses, budget planning, cost analysis shrink and inventory controls.
Customer Fraud Representative, 01/2008 to 09/2009
  • Customer Fraud Resolution Team Identifying valid and fraudulent charges, setting up fraud files, using multiple research techniques to resolve issues, reconciling and summarizing fraud losses and communicating with customers and/or banks to notify of inquiry or problem resolution Researched and analyzed complex issues related to customer accounts Communicated directly with customers on all issues of fraud pertaining to their deposit accounts Educated customers on ways to prevent and safeguard themselves from fraud Trained and assisted new employees.
Administrative Assistant, 01/2007 to 01/2008
  • Screened and routed incoming calls, took messages when necessary and conveying promptly.
  • Handled confidential company and employee's information with discretion, took inventory of office supplies, ordered products and safety equipment, scheduled maintenance and repair, setup drug screening and security clearance for specified companies.
  • Supervised 4-15 employees and assigned job placements with each employee ensuring they had all necessary equipment and supplies needed to complete tasks.
BS: Business Management, Expected in 2013
University of Phoenix - Birmingham, AL
Business Management
AS: Network Engineering, Expected in 2010
Virginia College - Birmingham, AL
Network Engineering
: , Expected in 2014
- ,
Managing Cosmetologist, Birmingham, AL: , Expected in 2006
- ,
Basic, Benefits, billing, budget planning, Hardware, cost analysis, Crystal Reports, client, customer services, Customer Service, customer service skills, Data Entry, Desktop Publishing, employee training, financial, firing, focus, Help Desk, hiring, human resource, ICD-9, Insurance, inventory, Lotus Notes, Managing, market, meetings, merchandising, Access, Excel, Microsoft Office Suite, office, 97, PowerPoint, Windows 9, Multi-Line Telephone, negotiation, Organizational, policies, problem resolution, problem solving skills, Processes, quality, Real Estate, reconciling, reporting, research, retail, safety, Sales, sales reports, scheduling, security clearance, SOP, staffing, strategy, Supervision, telephone etiquette, phone, Time Management, Translator, Written Communication Skills

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School Attended

  • University of Phoenix
  • Virginia College

Job Titles Held:

  • Client Services Representative
  • Healthcare Claims Specialist
  • Front End Billing Supervisor
  • Administrative Team Lead Medical Billing Specialist/Coder
  • Manager
  • Customer Fraud Representative
  • Administrative Assistant


  • BS
  • AS
  • Managing Cosmetologist, Birmingham, AL

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