Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:

Driven and motivated with a desire to work closely with both customers and coworkers. Proficient at reviewing and making knowledgeable decisions.

  • over a year's hands-on experience handling claims.
  • ability to read and decipher claim denials.
  • strong knowledge of medical terminology, ICD and CPT code.
  • over a year's worth of customer service experience.
  • Excellent interpersonal skills
  • High-energy attitude
Financial Clearance Specialist, 12/2014 to 08/2021
Anmed HealthAnderson, SC,
  • Managed and obtained insurance authorizations for patients.
  • Worked closely with patients to fill out paperwork and obtain necessary information in form of referrals and authorization overrides.
  • Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
  • Contacted insurance carriers to obtain authorizations, notifications and pre-certifications for patients.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Notified ordering providers of denied authorizations.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
  • Clarified patient inquiries and questions to update patient account information in computer system.
  • Created master spreadsheet to record procedures, denials and approvals.
  • Transmitted claims to insurance companies for payment and reconciled EOBs.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Accurately processed large volume of medical claims every shift.
Patient Registration Representative, 07/2011 to 11/2014
Children's Of AlabamaBirmingham, AL,
  • Updated patient demographic information to prevent treatment and recordkeeping errors.
  • Registered patients using proper data entry procedures and fully compliant ICD-10 and CPT codes.
  • Answered phone calls to provide assistance, information and medical personnel access.
  • Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services.
  • Conducted patient intake interviews to collect medical information and insurance details.
  • Compiled physical and digital documents, charts and reports.
  • Updated group medical records and technical library to promote smooth office operations.
  • Prepared and sent financial statements to support bookkeeping functions.
  • Maintained positive attitude and effectively de-escalated clients during crisis situations.
  • Answered and logged incoming inquiries via phone, fax and email.
  • Coordinated schedules and appointments, sending out reminders regarding appointment dates.
  • Issued, gathered and inspected intake forms to confirm correct signatures and information.
  • Investigated insurance policies to determine claim eligibility and processed files in accordance with instructions.
  • Managed average of 60 patients per day and processed new claims utilizing appropriate adjudication system.
  • Created and maintained accurate and confidential patient files according to regulatory mandates.
  • Completed claims forms for different types of appointments and worked on resolutions for denials or other insurance issues.
  • Communicated with patients to gather intake data and verify chart information.
Customer Service Representative Specialist, 07/2010 to 01/2011
Db SchenkerDallas, TX,
  • Researched resolutions, contacted necessary departments and responded back to customer back phone, mail or fax as follow up.
  • Kept customer and system account information accurate and current to support timely resolutions for concerns.
  • Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
  • Contacted insurance providers to verify insurance information and obtain billing authorization.
  • Assisted with updating patient profile information as needed.
  • Reviewed and submitted request for prescription refills.
Associate Customer Communication Specialist, 05/2006 to 06/2009
Coventry Health CareCity, STATE,
  • Managed multiple projects and tasks simultaneously while managing client expectations.
  • Supported customer service goals and enhanced relations through friendly, knowledgeable and positive communication.
  • Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
  • Met and exceeded productivity targets by handling every interaction with top-notch customer service.
  • Addressed inquiries, resolved customer issues and managed customer relations.
  • Assisted customers with the filing of Workers compensation, Auto liability, General liabitlity, Property liability, and Homeowners claims.
Education and Training
High School Diploma: , Expected in 06/1998
Plant City High School - Plant ,

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Job Titles Held:

  • Financial Clearance Specialist
  • Patient Registration Representative
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  • High School Diploma

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