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Jessica Claire
Montgomery Street, San Francisco, CA 94105
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary

Highly Motivated Tricare Subject Matter Expert with 15 years Experience in Customer Service, Quality Improvement, Claims research, Training and process improvement. Excellent Communication with Supervisory and Technical Skills. Recognized for Innovation and Creativity with Staff Development. Skilled in training staff and establishing rapport with clients. Self-motivated with communication and computer capabilities. Customer Service Representative with expertise in delivering support services and resolving customer complaints. Trained in Defense Enrollment Eligibility System, Microsoft word, excel, outlook, Pega, Careone, Omega, Rumba, CCM, NDB, Source HOV, Sharepoint, My guide, Medical terminology and Coding.

Skills
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Work History
11/2015 to Current
Clinical Administrative Coordinator Senior Cancer Care Northwest Coeur D Alene, ID,
  • Military Nac Clearance.
  • Subject matter expert for Tricare Prime Remote Section.
  • Extensive knowledge of Tricare Benefit Plans and Government Contracts for Foreign Nationals, Active duty, Retirees and dependents.
  • Data processing of referral request for all Active duty referrals.
  • Proficient on Department of Defense enrollment systems /DEERS - eligibility and enrollments.
  • Maintains complete responsibility for daily metrics and production standards for 19 team members.
  • Onboarding and continued Mentor support for all employees on team Adherence to strict turn around time of 92.5% of all notifications completed within 2 days and 100% of all notifications completed within 5 days to meet Government Contract Requirements.
  • Coding of all mtf referrals.
  • Inputting of Provider information into careone system.
  • Claims research /e2 escalations research to ensure beneficiaries received correct payments for care.
  • Work instruction updating and building.
  • Helped write DHA forms, and tpr work instructions.
  • Systems - Defense Enrollment Eligibility Reporting system, Pega, Carone, Pch, CCM, Rumba, Microsoft Outlook, Encoder Pro, My guide.
03/2014 to 10/2015
Tricare Prime Remote Prior Auth Coordinator UNITED HEALTHCARE MILITARY AND VETERANS City, STATE,
  • Maintains Military Security Clearance (NAC) Extensive knowledge of Foreign National Benefits, Tricare prime, standard, reserve select, Young adult and all active duty coverages.
  • Process referral request for all Active duty service members.
  • Data entry of Provider information.
  • Claims research.
  • Ability to answer questions for colleagues as needed.
  • Software - Pega, Careone, Pch, reflections, CCM, DOES, Microsoft Word, Microsoft Outlook, My guide, Knowledgent.
02/2013 to 03/2014
Customer Service Referral Representative UNITED HEALTHCARE MILITARY AND VETERANS City, STATE,
  • Maintain Military Security Clearance (NAC) Customer service walk-ins 10-18 beneficiaries per day to include benefit briefings, claims, enrollments and referral corrections.
  • Front desk check in for 65-100 beneficiaries daily.
  • Maintains high HIPPA Privacy Act Confidentiality and how it affects beneficiaries Benefits briefings for Tricare Prime, Standard, Tricare for Life, Reserve Select, Tricare Young adults.
  • Mass briefing for up to 250 deploying Reserve/Guard.
  • Enrollment entrance into DEERS- updating of beneficiary information, pcm and address changes Deers update for beneficiary to be able to enter into dmdc.
  • Calling or providers to obtain beneficiaries records for Military Treatment Facility providers.
  • Knowledge of claims and how coverage interacts with other insurance coverage's, contacting providers offices for claims information and updates.
  • software: CRIS, CHCS, inform screens, Does, Microsoft Outlook Proficient with all Tricare Plan code benefits including Active duty, foreign nationals, retiree benefits, reserve/guard and young adults.
  • Claims research and reprocessing.
  • Hand picked for TDY to Colorado, California and Tucson, AZ for manning assistance in Tricare Service Centers.
10/2002 to 03/2013
Tricare Service Representative TRIWEST HEALTHCARE ALLIANCE City, STATE, United States
  • Military Security Clearance (NAC) Performed benefits briefings for newcomers, retirees, Tricare for life, Active Duty, National Guard for up to 200 people.
  • Customer service to 14-20 walk-in beneficiaries for claims, benefits, enrollments.
  • processing of incoming referrals.
  • Faxing outgoing referrals.
  • Filing.
  • Understanding of HIPPA Privacy Act and enforcement.
  • Phone customer service - eligibility checks, referral information.
  • Knowledge of claims and how coverage works with other insurance companies.
  • Software: Microsoft Outlook, Word, Excel, Powerpoint, TACC, WRDA, DOES, CRIS, CHCS, Inform.
09/2001 to 04/2016
Manager, Tax preClairer, Trainer JACKSON HEWITT TAX SERVICE City, STATE,
  • Tax preClairer with an average of 200 returns per year Customer service - 3-16 returns per day.
  • Computer input of all client information.
  • Scheduling of 30 employees for 12 offices.
  • Analyzing and Troubleshooting returns for 12 stores.
  • Timesheets.
  • Closing of office daily.
  • Provider instruction preparing taxes and company procedures for 20-40 people per year.
  • Maintained all Continuing education according to IRS standards per year.
01/2018 to Current
Health Information Specialist Logistics Health Incorporated City, STATE,

Data entry -  Updating of records received for Reserve Guard annual medical care. Trained in Vision, Dental and general review. 

Customer Service - Calling and scheduling appointments for annual dental and medical care for reserve guard.

Education
Expected in
HIGH SCHOOL DIPLOMA:
Glendale Community College - Glendale, Az
GPA:
Skills
Benefits, Closing, Contracts, client, client relations, Customer service, Data entry, Data processing, Dependable, Faxing, Filing, finance, forms, Government, instruction, insurance, Medical Terminology, Mentor, Excel, office, Microsoft Outlook, Microsoft Outlook, Powerpoint, Word, Microsoft Word, works, NAC, Prime, Coding, Reporting, research, Rumba, Scheduling, Security Clearance, Tax preClairer, preparing taxes, Phone, Training development, Troubleshooting

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School Attended

  • Glendale Community College

Job Titles Held:

  • Clinical Administrative Coordinator Senior
  • Tricare Prime Remote Prior Auth Coordinator
  • Customer Service Referral Representative
  • Tricare Service Representative
  • Manager, Tax preClairer, Trainer
  • Health Information Specialist

Degrees

  • HIGH SCHOOL DIPLOMA

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