fraud specialist resume example with 6+ years of experience
Motivated to maintain customer satisfaction and contribute
to company success. Specialize in quality,speed & process optimization. Adept at working collaboratively to deliver timely and quality responses to service requests. Professional employee To seek and maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Qualified professional, passionate about promoting lasting customer satisfaction by delivering top-notch service and unparalleled support. Service-focused individual bringing 5+ years of experience in customer relations, task prioritization, claims processing and data analyzing.
Committed to Facilitate positive experiences through high-quality client care and prompt resolution of complaints and issues. Motivated to maintain customer satisfaction and contribute to company success.
Focused Fraud Analyst with highly developed skills that truly shine when identifying anomalies and teaming up with staff members for brainstorming purposes. A valuable and committed professional with dynamic communication and interpersonal skills. Ready to take on a new role with a company where a strong work ethic and calm demeanor will be appreciated.
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- Determined existing fraud trends by analyzing accounts and transaction patterns.
- Conducted reviews of flagged transactions and reports that showed potential suspicious activity.
- Analyzed and reviewed confidential and highly sensitive investigative material concerning various parties.
- Responsible for identifying suspicious activity on accounts while reducing company losses and making sure the customer is educated about iraud and identity theft. Regularly had to go above and beyond normal job duties to identify any activity that may have been overlooked by the system. Always make sure the customer has no doubt that they were heard and their issue is being handled with care and professionalism. Consistently recognized for receiving excellent surveys from customers expressing their gratitude for the world class service I was able to provide.
- Consulted via telephone to understand user problems, run through testing scripts and ask probing questions to locate root
- causes.
- Received inbound phone calls from customers to provide first-level support and remotely troubleshoot issues with service, equipment or customer accounts.
- Collaborated with support team to assist client stakeholders with emergent technical issues and develop effective solutions.
- Communicated with customers to identify issues, walk through solutions and initiate corrective actions to restore service and functionality.
- Documented and updated case notes for each customer and work order.
- Worked with supervisors via live chat to address customer inquiries or technical issues beyond scope of expertise.
- Assessed issues to determine appropriate troubleshooting methods for remediation.
- Assist agents with customers to facilitate the customers issues.
- Communicate via message with agents and other T2 agents to make sure our job is done more efficiently. Assist customer via chat with their account so they can have an easy and helpful experience.
- Checked patients in and out for appointments and collected co-payments.
- Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
- Managed office phone lines by checking voicemail, returning calls and directing messages to team members.
- Critical Thinking
- Call Transfers
- HIPAA Guidelines
- Patient Health Information Access Referral Tracking Patient Referral
- Adhered to strict HIPAA guidelines to protect patient privacy. Coordinated patient scheduling, and payments for billing.
- Managed multi-line phone system and pleasantly greeted patients. Helped patients complete necessary medical forms and documentation. Checked patient insurance, demographic and health history to keep information current.
- Senior Disability Claim
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Communicated with other departments to establish action plans and manage open claims to closure.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Analyze and trend claims issues, performs true root cause analysis, and determines next steps for resolution and process improvements
- Calculated adjustments, premiums and refunds. while Processing and recording new policies and claims. Made contact with insurance carriers to discuss policies and individual patient benefits.
- Responsible for handling assigned claims cases in a timely manner to identify opportunities to resolve the issue by working with plan documents
- Resolves issues that are adversely impacting claims submission in a timely and accurate manner.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Placed outbound customer service or customer satisfaction calls to follow up on issues.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction. Documented and detailed calls and complaints using call center's CRM database.
- Interviewed policyholders to verify information and obtain additional details.
- Proposed settlements for uncomplicated issues to resolve claims.
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Resume Overview
School Attended
- Chamberlain High School
Job Titles Held:
- Fraud Specialist
- Medical Receptionist
- Senior Disability Claim Specialist
- Customer Service Representative
Degrees
- High School Diploma
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