Consumer Service Representative Ii Resume Example

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Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:

Experienced, remote working, Consumer Service Associate bringing 15+ years of applying exceptional customer service and non-clinical support to varying types of medical teams. Nearly three years of experience with Anthem Blue Cross Blue Sheild in the Member Services department utilizing outstanding conflict mediation, and communication skills to address diverse needs, mainly claims/benefits inquiries. Responsive and resilient team player with adaptable and resourceful mindset. Highly motivated to apply my passion for success, my analytical excellence, and my experience to serve the goals and missions of your team.

Work History
Consumer Service Representative II, 10/2018 to Current
Carpenter Health Network Clinton, MS,
  • Provided concierge style customer service to include addressing complex claims inquiries.
  • Answered up to 60 incoming calls/chats per day in a busy, fast-paced work from home call center environment with little support needed.
  • Addressed incoming member inquiries regarding prior authorization, claims, benefits, and enrollment concerns.
  • Forwarded documentation (appeals, claims, hipaa authorizations, etc.) to the appropriate departments.
  • Updated customer accounts and system database with latest details to support accuracy and efficiency in future interactions.
  • Defused and deescalated escalating member concerns with exceptional conflict resolution skills.
  • Provided support to fellow employees as needed.
  • Followed up with members/facilities to address lingering concerns.
  • Assisted management with member call backs.
  • Coordinated timely responses to online customer communication and researched complex issues.
Medical Records Coordinator, 02/2015 to 09/2018
Kindred Hospice City, STATE,
  • Maintained accuracy, completeness and security of medical records and health information including HPI
  • Accurately transferred paper records to the EMR system
  • Coordinated veterans pinning ceremonies and honor salutes
  • Processed record requests for subpoenas, insurance companies, patients, and their families
  • Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery
  • Developed and nurtured lasting customer relationships by projecting professional corporate image and responding quickly to issues
  • Protected privacy and delivered comfort to preserve dignity of patients and family members
  • Organized clinical documentation, treatment plans, and referrals
  • Mentored new hires, resulting in stronger staff development and increased productivity
  • Resolved conflicts and negotiated mutually beneficial agreements between parties
Geriatric Medical Assistant, 05/2014 to 12/2014
Riverside Medical Group City, STATE,
  • Ensured confidentiality of patient information and data
  • Gathered statistical information on patient admissions, discharges, births, deaths and treatments administered for physician review
  • Reviewed charts and flagged incomplete or inaccurate information
  • Managed office logistics by scheduling appointments, maintaining files and collecting payments
  • Recorded medical history and vital signs of children, adults, and seniors
  • Assisted physicians with in office medical procedures for children, adults, and seniors
  • Implemented care and efficiency improvements to support and enhance office operations
  • Responded to correspondence from insurance companies to verify patient's coverage
  • E-prescribed medications under the supervision of a physician
  • Enhanced patient outcomes by providing knowledgeable education on procedures, medications and other physician instructions to new hires
Geriatric Medical Assistant, 06/2012 to 05/2014
Advanced Adult Daycare City, STATE,
  • Maintained accuracy, completeness and security of medical records and health information
  • Accurately pulled patient records for upcoming appointments and procedures
  • Obtained patient vital signs and maintained records of clinical findings
  • Worked with supervisors and team members to understand supply needs and bring levels within desired tolerances
  • Collaborated with team members to help expand marketing channels
  • Provided ADL assistance as needed
  • Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment
  • Responded to patient emergencies
  • Trained new hires on department procedures and policies to maximize department effectiveness
  • Provided detailed instruction and role modeling for acceptable social and work-related behaviors
Master of Arts: History, Expected in 2018
Southern New Hampshire University - Manchester, NH,
  • Graduated cum laude
  • Graduated with 3.9 GPA
  • Coursework in American History, Historiography, and African History
Bachelor of Arts: History, Expected in 2016
Excelsior College - Albany, NY,
  • Graduated cum laude
  • Majored in History
  • Coursework in American History, Public History, and African History
Medical Office Technology Certificate: Medical Office Technology, Expected in 2012
Drake School of Business - Newark, NJ,

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Resume Overview

School Attended
  • Southern New Hampshire University
  • Excelsior College
  • Drake School of Business
Job Titles Held:
  • Consumer Service Representative II
  • Medical Records Coordinator
  • Geriatric Medical Assistant
  • Geriatric Medical Assistant
  • Master of Arts
  • Bachelor of Arts
  • Medical Office Technology Certificate