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customer service claims representative resume example with 7+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Possess high levels of enthusiasm towards projects focused on organizational transformation through continuous organizational risk reduction and process improvement initiatives. Expertise in coordinating and managing collaborative programs, building alliances and partnerships.

o Self-directed and self-motivated individual with an established reputation of professionalism, expert knowledge, performance excellence and foster a positive work environment. Possess strong organizational and multi-tasking abilities; communications and analytical skills; effective writing, presentation and problem solving skills; focused on customer service and operational efficiency; and thrive in both team and individual work environments.

o Demonstrated leadership, tenacity, thoroughness, and dedication, with solid work ethic and friendly demeanor in executing professional responsibilities. Established record of accomplishments in developing and implementing both short-term objectives and long-range strategic goals and managing key logistics necessary for critical goal setting. Rapidly learns new procedures and processes; quickly adjust to changes in schedule, environment and organizational objectives; facilitate atmosphere of collaboration and support.

o More than 6 years of progressive leadership, retail, and management expertise in sales, marketing, customer services, training, inventory, branding, policies and procedures development, financial, program/project development, implementation, and evaluation; performance/process improvement; shrinkage data analytics; transformation/business process reengineering/redesign; and management and operations in organizations settings.

Skills
  • Inventory Control
  • Customer Service
  • Friendly and Outgoing
  • Products Knowledge
  • Payment Processing
  • Service Consultations

SELECTED JOB RELATED SKILLS: Proficient in the use of Microsoft Office 2010, 2007, 2003; Zoom, Search Engine, Microsoft Webex, Microsoft Team, Access; Excel; PowerPoint; Publisher; Microsoft Project; Windows Vista, XP, 95, 98, 2000, NT, 2003, XP, 2007

Role-Playing➢ Quality Assurance➢ Sales Performance➢ Budget➢ Financial Statements

  • Flexible Schedule
  • Good Work Ethic
  • Problem Resolution
  • Planning & Organizing
  • Supervision & Leadership
  • Team Building
  • Microsoft Office
  • Active Listening
  • People Skills
  • Computer Skills
  • Organizational Skills
  • Reliable & Trustworthy
  • Relationship Building
  • Training & Development
  • Basic Math
  • Critical Thinking
  • Friendly, Positive Attitude
Experience
Customer Service /Claims Representative, 05/2019 - 08/2022
Liberty Mutual Hauppauge, NY,
  • Communicated with other departments to establish action plans and manage open claims to closure.
  • Verified claim data correctness in preparation for processing.
  • Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
  • Reviewed history records to determine benefit eligibility for services.
  • Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
  • Handled billing related activities focused on medical specialties.
  • Collected payments, processed receipts and informed policyholders of outstanding balances.
  • Used insurance rate standards to calculate premiums, refunds, commissions and adjustments.
  • Answered patient questions and fielded complaints to resolve issues.
  • Obtained insurance verification and authorization to submit financial clearance of patient accounts.
  • Referred patients to appropriate professionals and services.
  • Precisely calculated refunds, premiums and adjustments.
Customer Service Representative/Account Billing Specialist, 12/2017 - 12/2020
Comcast, Xfinity City, STATE,
  • Motivated sales associate with sales experience. Independent worker with high energy and great communication skills. Reliable and friendly professional able to work with little oversight and collaborate in team environments. Inspiring, passionate, and commitment among my peers leading to a culture of excellence that is centered around customer services. Progressive track record of creating a vision, project plan, and strong leadership, discipline, and diversity base initiatives. Excellent organizational, customer services, computer, and communication skills necessary to provide clear communication in informational, and compliance reports
  • Developed strong customer relationships to encourage repeat business.
  • Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
  • Assisted customers with making payments or establishing payment plans to bring accounts current.
  • Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
  • Answered inbound calls, chats and emails to facilitate customer service.
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
  • Documented customer information and activity in customer database.
  • Listened to client concerns and asked questions to better understand needs.
  • Documented specific claims by completing and recording forms, reports and logs.
  • Signed payment approvals accepted claims.
  • Made outbound calls to obtain account information.
  • Verified claim data correctness in preparation for processing.
  • Organized information by using spreadsheets, databases or word processing applications.
  • Managed all payments processing, invoicing and collections tasks.
  • Processed invoice payments and recorded information in account database.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
Claims Customer Care Representative, 12/2014 - 12/2017
Humana City, STATE,
  • Answered insurance-related questions and discussed product offerings with prospective customers to meet unique needs.
  • Navigated computer system to look up customer information and update policies.
  • Assisted claimants, providers and clients with problems or questions regarding claims.
  • Processed claims for payment or forwarded to appropriate personnel for further investigation
  • Examined claims, records and procedures to grant approval of coverage.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Collaborated with fellow team members to manage large volume of claims.
  • Used insurance rate standards to calculate premiums, refunds, commissions and adjustments.
  • Assisted new policyholders with processing claims.
  • ‪Responded quickly to customer inquiries, needs and problems.‪
  • Consulted with customers regarding needs and addressed concerns.
  • Audited customer account information to identify issues and develop solutions.
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
  • Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
  • Answered inbound calls, chats and emails to facilitate customer service.
Education and Training
Associate of Business Administration : Business Administration And Management, Expected in 06/2019
-
Hinds Community College - Raymond, MS
GPA:
Status -

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Resume Overview

School Attended

  • Hinds Community College

Job Titles Held:

  • Customer Service /Claims Representative
  • Customer Service Representative/Account Billing Specialist
  • Claims Customer Care Representative

Degrees

  • Associate of Business Administration

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