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fraud prevention specialist resume example with 3+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Professional Summary

Highly ambitious and committed Nationally Registered Certified Medical Assistant with further education in Healthcare. Proven history of superior performance at team, and individual levels. Strong in the area of prioritizing and multitasking workloads. Well-spoken, detail-oriented, quick learning professional with desire to bring medical background, and team-building skills to a goal-driven environment.

Skills
  • Medical Terminology Proficient
  • Active Listening
  • Microsoft Office Proficient
  • Interpersonal Communication
  • Analytical Skills
  • Administrative
  • Adaptability
  • Emotional Intelligence
  • Interpersonal Communication
  • Teamwork
  • Critical Thinking
  • Computer Application Expert
Education
University of Arkansas Eversity Online, Expected in 07/2021 Associate of Arts : Healthcare Management - GPA :
Eastern College of Health Vocations Little Rock, AR Expected in 08/2017 Medical Assistant Diploma : Medical Assistant - GPA :

Current Nationally Registered Certified Medical Assistant Certification through National Association for Health Professionals

Work History
Bass Pro Shops - Fraud Prevention Specialist
Saint Charles, MO, 04/2020 - 04/2021
  • Answered high volume, fast-paced inbound customer inquiries in Avaya/Humanify as unemployment benefits Fraud Prevention Specialist in professional work from home setting
  • Authenticated customers via soft background check investigative tools; Validated flagged transactions during in-depth account review to provide timely solutions
  • Performed exceptional level of service to each customer by listening to concerns, displaying empathy and providing customer education
  • De-escalate calls if needed; escalated calls to supervisor if necessary
  • Achieved quick resolution through attention to detail coupled with research analysis of each case
  • Provided strong documentation on all accounts of steps taken and any recognized fraud trends
  • Refer customers to other departments if further resolution required
  • Navigated multiple computer programs with ease during every customer interaction
  • Maintained required AHT of 5 minutes
  • Consistently maintained 100% out of expectant 95% reliability attendance record
  • Use of company troubleshooting resolution flow to determine technical problems while leveraging personal expertise to find appropriate solutions
Aetna Inc. - Claims Benefit Specialist
Absecon, NJ, 11/2020 - Current
  • Positioned as go-to person for up to 24 staff members, troubleshooting complex administrative and training issues promptly
  • Microsoft Word, Excel, Outlook, PowerPoint proficiency; Microsoft Access knowledgeable
  • Mentored and guided employees to foster proper completion of assigned duties in remote setting
  • Cross-trained and provided backup for other Team Leaders
  • Coordinated weekly meetings for internal groups, including Zoom, Microsoft Teams, and Skype meetings for interacting with all levels of management
  • Participated in cross-functional team-building activities
  • Provided constructive criticism coaching regarding quality assurance on agent phone calls to teams in order to meet certain metrics
  • Performed verbal and written corrective action plans for non-compliant employees
  • Encouraged teams on team chat in Mattermost, Pidgin; Slack knowledge
  • Bridge of communication between employees and various Human Resources departments
Baptist Health Women's Clinic - Nationally Registered Certified Medical Assistant
City, STATE, 04/2018 - 09/2019
  • Promoted office efficiency by assisting with diverse clinical administrative tasks such as completing FMLA and disability insurance documents
  • Proficient with EPIC system EMR; Knowledgeable with Athena EHR
  • Completed insurance prior authorization requests for procedures, medical equipment and medications through online portals or via verbal communication
  • ICD-9-CM; ICD-10-CM Internal Classification of Disease Proficient; Coded minimum 30 patients charts per day during pre-charting for medical billing; Current Procedural Terminology (CPT) Proficient
  • Scheduled OB/GYN Cesarean, Tubal Ligation, Hysterectomy, Oophorectomy surgeries and assured patient consent forms signed
  • Performed weekly physician documentation audits to ensure any actions taken support visit type for billing purposes as Registered Medical Assistant
  • Assisted with back-office inbound and outbound patient and pharmacy inquiries
  • Provided timely accurate medication refills
  • Ordered pertinent patient labs as necessary
  • Performed standard daily quality control and instrument sterilization in-clinic laboratory for audit trail
  • Interpersonal communication in HIPAA compliant manner to maintain confidentiality
  • Collected then documented patient medical history such as blood pressure, pulse ox reading, and weight in Electronic Health Record
  • CMA prepared then administered medications to alleviate patient symptoms
  • Assisted physician(s) with minor outpatient procedures

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Resume Overview

School Attended

  • University of Arkansas Eversity
  • Eastern College of Health Vocations

Job Titles Held:

  • Fraud Prevention Specialist
  • Claims Benefit Specialist
  • Nationally Registered Certified Medical Assistant

Degrees

  • Associate of Arts
  • Medical Assistant Diploma

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