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

Experienced Credentialing Specialist adept at conducting application reviews and primary source verifications. Excellent relationship-building, problem-solving and communication skills. Seeking to be part of a company that gives the opportunity to grow and earn CPCS certification.

  • Time Management
  • Adaptability
  • Research
  • Teamwork
  • Problem Solving
  • Strong work ethic
  • Interpersonal and communication
  • Conflict Resolution
  • Problem Solving
  • Processes
  • Quality control
  • Research
  • Time Management
Work History
10/2019 to Current
Credentialing Specialist Dignity Health Redding, CA,
  • Possess knowledge and understanding of the reappointment process.
  • Obtains current certificate of insurances, medical licenses, DEA certificates, life support certificates, and other required expirable documents from Healthcare Providers.
  • Possess excellent interpersonal and communication skills and the ability to work independently as well as part of a team.
  • Processes and review Reappointment Applications for Physicians and Allied Health Practitioners following the Medical Staff Bylaws, Rules and Regulations, and the policies and procedures for Credentialing.
  • Maintain confidentiality of Providers Data
  • Maintain the Practitioners database by updating or imputing new information regarding Jobs, Education, Licenses, Training, etc.
  • Process and properly document resignations, temp inactivation due to expirable documents, leave of absences, etc.
  • Communicates effectively with Practitioner regarding any expirable document, or any missing information during reappointment process.
  • Performs Primary Source Verification(PSV ) for medical licenses, boards, hospital Affiliations, national practitioner data bank ( NPDB) queries, Federation of State Medical Board ( FSMB ), Florida office of insurance regulation ( DOI ) , DEA diversion control
05/2016 to 10/2019
Interviewing Clerk Florida Department Of Transportation Rockledge, FL,
  • Answer general inquiry questions related to program requirements, application processing, case status and benefits information.
  • Educate customers on community partners and the benefits/features of my Access Account.
  • Assist customers with referrals to other agencies and community resources.
  • Conducts abbreviated interviews for the purpose of collecting and updating required information on applicants and recipients and their household members for all public assistance programs.
  • Requests all additional information/verification required to establish or continue eligibility for public assistance programs according to Department procedures.
  • Ensure electronic case records are documented thoroughly and properly as required by department procedures.
  • Takes appropriate corrective action on identified error through the quality management system, management evaluation reviews, and quality control reviews.
  • Maintain and develops professional knowledge and skills by participating in supervisory performance conferences, staff meeting, mandatory training and workshops as assigned or required.
  • Performs special work assignments and other related work duties as required or assigned.
06/2015 to 02/2016
Health Insurance Agent American National Insurance Company Essington, PA,
  • Highly experience in assessing customers' needs and advising coverage options.
  • Hands on experience in developing and maintaining relationships with customers.
  • In depth knowledge of standard insurance products, pricing, and policy features.
  • Assessed needs and provide coverage options.
  • Calculated premiums amount and set payment methods and options.
  • Determined if prospect qualifies for financial assistance based on Household Size and Projected Income.
  • Educated prospect in different ways to apply.
01/2013 to 10/2014
Fraud Analyst Asea Pleasant Grove, UT,
  • Handled inbound service calls from customers.
  • Assisted customer to set up claims related to fraud or disputes covered under regulation.
  • Answered questions regarding new &existing fraud & dispute claims within standards.
  • Resolved problems & complaints that customers may have about Regulations.
  • Setting up check fraud, identity theft & wire fraud cases & handle fraud detection calls.
  • Ability to make decisions using knowledge of policies procedures & regulations.
  • Conducted research on moderately complex customer issues.
  • Received & resolved most complex calls customer issues & interpret policy & procedure.
  • Educated customer and offer tools to help them avoid fraud and identity theft.
  • Reported any unusual activity on accounts in order to protect the bank ( Fraud Saves).
Expected in 06/1999
BBA: Business Administration
Pontificia Universidad Javeriana - Cali, Colombia,

• Being an effective Team Member 12/2020
• Customer Service: Serving Internal Customers 12/2020
• Conflict Resolution Foundations 10/2019
• Social Media Marketing Tips 08/2019
• Managing Brand reputation 08/2019
• Cybersecurity Awareness: Social Network at Work 08/2019
• Building Online Communities 08/2019
• Phone-Based Customer Service 08/2019
• Customer Service: Creating Customer Value 08/2019

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School Attended

  • Pontificia Universidad Javeriana

Job Titles Held:

  • Credentialing Specialist
  • Interviewing Clerk
  • Health Insurance Agent
  • Fraud Analyst


  • BBA

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