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Customer service claims representative Resume Example

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CUSTOMER SERVICE CLAIMS REPRESENTATIVE
Summary
Service/Goal -oriented Account Specialist with 10 year back ground in customer service. Demonstrated planning and organizational skills.Established verbal and written communication skill . Proven business mathskills and Proven aptitude and skills to excel in a results-driven in acustomer-focused environment. As well demonstrated basic computer skills.Provided support to the sales team, ensuring all sales and service objectiveswere met.Motivated leader with strong organizational and prioritization abilities.Track record of achieving exceptional results in customer service and technical assistance. Handle tasks with accuracy and efficiency. Passionate and motivated with a drive for excellence.Developed positive relationships with customers to ensure revenue and trust .
Highlights

  • Active Listening
  • Mathematics  
  • Complex Problem Solving
  • Judgment and Decision Making
  • Critical Thinking
  • Clerical
  • Scheduling
  • Time Management
  • Administration and Management
  • Systems Analysis
  • Customer and Personal Service
  • Instructing
  • Computers and Electronics
  • Skilled multi-tasker
  • Training and development

Accomplishments
Resolved customer complaints by identifying problems and taking appropriate corrective action .
Demonstrated professional etiquette and manners when interfacing with customers which improved feedback of customers.
Attained Employee of the month Award 3 times in 5  6 months following commendation from supervisors and recommendation from peers.
​
Experience
October 2015
to
Current
SedgwickOrlando, FLCustomer service claims representative
Made reasonable procedure exceptions to accommodate unusual customer requests.
Determine the amount of coverage a customer should receive according to the procedure done .
Assist in  coverage on the account an Stay in constant contact with medical facilities providing service to determine accuracy of claims being made .
Meet with customers to discuss results of claims explaining the process and outcome.
Research current and new medical processing laws and regulations at both the state and federal level .
Train new Medical Claims Processors in all aspects of the job Provided accurate and appropriate information in response to customer inquiries.
File medical claims made by customers by entering and organizing data and inputting all information into the computer system Determined the amount of coverage.
Maintained up-to-date records at all times. Developed effective relationships with all call center departments through clear communication.
Ran reports and supplied data to fulfill customer report requirements.
Formulated and enforced Service Center policies, procedures and quality assurance measures.
Trained staff on how to improve customer interactions.
Facilitated information flow between customer service, account management operations, quality assurance, training and payroll departments to guarantee call center objectives were met.
September 2011
to
October 2015
Sears HoldingsLake Mary, FLSr. Account Specialist
  • Use computers for various applications, such as database management or word processing.
  • Create, maintain, and enter information into databases.
  • Schedule and confirm appointments for clients, customers.
  • Supervise other clerical staff and provide training.
  • Provide customer service, such as limited instructions on proceeding with claims or referrals to local contractors for repairs.
  • Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.
  • Calculate amount of claim.
  • Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.
  • Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
  • Review insurance policy terms to determine whether a particular loss is covered by insurance.
  • Determine charges for services requested, collect deposits or payments, or arrange for billing.
  • Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
  • Resolve customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills.
February 2010
to
October 2010
Lake Mary, FLcustomer service/Technical specialist
  • Solicit sales of new or additional services or products.
  • Compare disputed merchandise with original requisitions and information from invoices and prepare invoices for returned goods.
  • Refer unresolved customer grievances to designated departments for further investigation.
  • Contact new and existing customers to discuss their needs, and to explain how these needs could be met by specific products and services.
  • Answer customers' questions about products, prices, availability, or credit terms.
  • Emphasize product features based on analyses of customers' needs and on technical knowledge of product capabilities and limitations.
  • Negotiate prices or terms of sales or service agreements.
  • Prepare sales contracts for orders obtained, and submit orders for processing.
  • Provide customers with ongoing technical support.
  • Demonstrate and explain the operation and use of products.
  • Inform customers of estimated delivery schedules, service contracts, warranties, or other information pertaining to purchased products.
November 2006
to
May 2010
TJ MaxxOrlando, FLCustomer service Coordinator//cashier
  • Receive payment by cash, check, credit cards, vouchers, or automatic debits.
  • Issue receipts, refunds, credits, or change due to customers.
  • Assist customers by providing information and resolving their complaints.
  • Count money in cash drawers at the beginning of shifts to ensure that amounts are correct and that there is adequate change.
  • Greet customers entering establishments.
  • Process merchandise returns and exchanges.
  • Monitor checkout stations to ensure that they have adequate cash available and that they are staffed appropriately.
  • Supervise others and provide on-the-job training.
  • Plan and direct staffing, training, and performance evaluations to develop and control sales and service programs.
  • Monitor sales activities to ensure that customers receive satisfactory service and quality goods.
  • Assign employees to specific duties.
  • Examine merchandise to ensure that it is correctly priced and displayed and that it functions as advertised.
  • Identify and report safety concerns to maintain a safe shopping and working environment.
  • Conduct store audits to identify problem areas or procedural deficiencies.
Education
Aug 2009
Westside Tech Winter Garden, FLHigh School Diploma: cosmetology
May 2008
Ocoee High SchoolOcoee, FLHigh School Diploma
Skills
billing, clerical, contracts, credit, clients, customer service, databases, database management, Decision Making, delivery, Electronics, features, Instructing, insurance, prepare invoices, Issue receipts, Listening, Mathematics, access, money, office, Problem Solving, quality, recording, repairs, safety, sales, staffing, Systems Analysis, technical support, telephone, Time Management, word processing
Additional Information
  • Awards Top Performer, Inside Sales Team, 2007 Outstanding Achievement in Customer Satisfaction, 2013
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Resume Overview

Companies Worked For:

  • Sedgwick
  • Sears Holdings
  • TJ Maxx

School Attended

  • Westside Tech
  • Ocoee High School

Job Titles Held:

  • Customer service claims representative
  • Sr. Account Specialist
  • customer service/Technical specialist
  • Customer service Coordinator//cashier

Degrees

  • High School Diploma : cosmetology
    High School Diploma

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