Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,
Professional Summary

Well-organized Administrative professional bringing excellent multitasking abilities developed over 10 years of administrative experience. Commended for consistently driving team success with knowledgeable enforcement of company procedures and skillful personnel training.

  • Insurance Verification
  • Clerical assistance
  • Telephonic Customer Support
  • Medical terminology
  • Documentation skills
  • Case review
  • Medicare/Medicaid
  • ICD 10 Coding
  • Provider Relations
  • Claims assessments
  • HIPAA compliant
  • Medical database expertise
  • LINX
  • EMR
  • UNET
  • Case management
  • Medical Records management
Work History
11/2021 to 01/2022 Claims Specialist - Title II Unitedhealth Group Inc. | Lyndhurst, NJ,
  • Calculated adjustments, premiums, and entitlements based on data provided by claimants and other agencies.
  • Displayed exceptional customer service skills and critical thinking methods.
  • Conducted full claim investigations and reported updates and legal actions.
  • Utilized POM references to file claims and quote policies within SSA guidelines
  • Addressed over 50 daily claimant inquiries via phone lines and in person appointments.
  • Checked proof documentation for accuracy and validity on updated systems.
  • Maintained confidentiality of claimant finances, records and demographic data.
  • Verified client information by analyzing existing evidence on file.
05/2021 to 11/2021 Healthcare Administrative Coordinator- Remote Cvs Health | New Albany, OH,
  • Completed onboarding and follow up app support for virtual therapy patients
  • Intercepted an average of 50 voicemails per day from patients in need of mental health services
  • Handled patient scheduling, technical support, and prescription requests
  • Drafted service animal documents, doctor's notes, and session summaries for providers
  • Addressed questions from patients and business partners with empathy and professionalism.
  • Performed troubleshooting via zoom prior to virtual appointments when requested
  • Resolved issues through active listening and open-ended questioning, escalating major problems to therapists or psychiatrists.
  • Advised health care professionals on proper administrative procedures and how to use programs such as CARE, keeping operations consistent and efficient for maximum performance.
  • Created help desk tickets, troubleshot and resolved desktop issues.
03/2018 to 04/2021 Clinical Administrative Coordinator Magnolia Bakery | New York, NY,
  • Primarily responsible for the assessment of mental health and substance abuse claims while assigning to properly licensed care advocate within a 2-hour turnaround deadline.
  • Responsible for patient medical records relating to substance use and/or mental health treatment.
  • Extend a medical facility’s request for additional service coverage based on clinical data provided.
  • Electronically submit exception forms through a portal when a patient’s treatment requires services that are out of network.
  • Creating and editing step-by-step guides for the team when the department takes on new functions.
  • Reaching out to various hospitals, clinics, and treatment centers whenever there is a claim discrepancy to ensure Medicaid/Medicare deadlines are met.
  • Utilizing ICUE clinical system to enter procedure and ICD-10 diagnosis codes into a member’s clinical history.
  • Reviewing Washington and Louisiana claims to match units with corresponding HCPCS codes Fulfilling a minimum of 85 patient claims assignments per day while maintaining a monthly accuracy average of 98%.
  • Contacting facilities where high-needs members received treatment to confirm a discharge date or extension of services.
  • Collaborating daily with utilization review teams to ensure proper discharge arrangements have been made
  • Partnering with clinical staff to fast track admittance of suicidal members in need of mental health treatment
  • Performed patient census operations, collecting data to generate a comprehensive profile of practice's performance.
11/2016 to 03/2018 Member Advocate UnitedHealth Group | City, STATE,
  • Primarily responsible for answering incoming calls from Medicaid and Medicare members
  • Initiated Network Analysis project that improved accuracy of information within the online directory of in-network facilities Memorized and applied Medicaid/Medicaid benefits for states of Arizona, Maryland, Michigan, and Louisiana
  • Maintained patient medical records with data obtained from providers
  • Partnered with members’ in-network pharmacy to remove blocks in dispensary process as needed
  • Completed HEDIS assessment for applicable members to determine which benefits were being underused, and assisted them with making appointments to increase benefit usage
  • Acted as point of contact for new employees during their onboarding period on the production floor.
  • Advised inquiring members of any gaps in coverage and how to go about reinstating Medicaid/Medicare benefits with their state
  • Helped vulnerable individuals navigate the healthcare system.
06/2015 to 11/2016 Senior Account Resolutions Specialist Getix Health | City, STATE,
  • Managed a team of 10 employees for medical revenue cycle management
  • Facilitated monthly team meeting to go over projections and previous month’s performance
  • Answered escalated calls from guarantors of hospital balances
  • Reviewed hospital claims to ensure proper ICD-10 codes were used, and that all responsible parties were billed correctly
  • Participated in meetings with upper management to report trends and suggest new processes.
  • Reviewed account activity to assess financial status and evaluate discrepancies.
  • Reviewed patient medical records when to process disputes and grievances.
05/2013 to 05/2015 Customer Service Agent Xerox Business Services | City, STATE,
  • Hours per week: 40, Served customers, via inbound calls, by providing product and service information while resolving product and service problems.
  • Assist potential customers by answering product and service questions while suggesting information about other products and services.
  • Analyzed account data to resolve billing disputes, and provide real-time work order statuses
  • Resolved product or service problems by clarifying the customer’s complaint, determining the cause of the problem, selecting and explaining the best solution to solve the problem, expediting correction or adjustment, and following up to ensure resolution.
  • Recommended additional products or services to management by collecting customer information and analyzing customer needs.
  • Prepared product or service reports by collecting and analyzing customer information.
  • Provided primary customer support to internal and external customers in fast-paced environment.
  • Sought out training opportunities to enhance customer relationship management abilities and further boost satisfaction scores.
Expected in 05/2012 Associate of Science | Communication Sciences And Disorders University Of Houston, Houston, TX GPA:

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School Attended

  • University Of Houston

Job Titles Held:

  • Claims Specialist - Title II
  • Healthcare Administrative Coordinator- Remote
  • Clinical Administrative Coordinator
  • Member Advocate
  • Senior Account Resolutions Specialist
  • Customer Service Agent


  • Associate of Science

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