Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Core Qualifications
  • Professional summary
  • Motivated leader with strong organizational and prioritization abilities. Accomplished, dependable, energetic team player that is dependable, a self-starter with a concrete history of achievement in membership services. Areas of expertise include billing, customer service and communication.
  • skills
  • Clerical and Case Management
  • Customer and Personal Service
  • Active Listening
  • Time Management
  • Judgement and Decision Making
  • Complex Problem Solving
  • Microsoft Applications - Outlook, Lync, Word, Excel, Access
  • Systems used at Anthem, Inc. - Medisys, Legacy Core Facets, Medicare Part D Facets, GBD (Government Business Division) Facets, Ultera Imaging System, OLS -Online Sales Applications, MARx - CMS Center for Medicare and Medicaid Services, PeopleSoft Accounts Receivable, ORCC EFT Payment System, Compass - Customer Inquiries and the Smart Tool
  • Peer Training
  • Identifies processing errors for coaching opportunities
11/2015 to Present Front Office Receptionist Mednax | Tampa, FL,
  • Greeting Patients.
  • Scheduling appointments.
  • Preparing patient documents and entering in information.
  • Answering and routing phone calls.
  • Calling patients for appointment reminders.
  • Checking messages.
  • Recording/photocopying patients insurance information.
  • Patients referrals.
  • Insurance referrals and prior authorizations.
  • Scanning all medical records in patients chart.
  • Medication prior authorizations.
  • Making sure well and sick waiting rooms are neat and cleaned.
  • Checking patients eligibility (passport, availity, and commercial insurances) and benefits.
  • Balancing daily transactions and money drawer.
  • Help post payment.
08/2013 to 07/2015 Billing Membership Representative II Anthem Blue Cross Blue Shield | City, STATE,
  • Accurately process billing functions timely according to desk procedures and CMS guidance for Medicare membership.
  • Respond to incoming calls and initiating outgoing calls, providing customer service to plan members, providers and employer groups by answering benefit questions, resolving issues and educating callers.
  • Premium Billing for Medicare Advantage and Medicare Part D members.
  • Research and resolved delinquent member accounts.
  • Ensure accuracy and timeliness of billing functions.
  • Bill, collect premiums and reconcile payments.
  • Review, maintain and reconcile premium billed individual accounts.
  • Confirms eligibility benefits to ensure billing is accurate.
  • Notify clients of premium discrepancies through payment adjustment notices and detailed audits.
  • Thoroughly document inquiry outcomes for accurate tracking and analysis.
  • Perform basic job functions with help from co-workers, specialists and managers on non-basic issues.
  • Reduce inventory on a daily basis.
  • Meets individual quality at 100% and production goals at 120% and above.
  • Provides outstanding customer service by ensuring customer requests and questions are handled appropriately and in a timely manner.
  • Acts as a liaison between internal departments to support membership correspondence research.
  • Performs peer training.
02/2000 to 08/2013 Underwriting Customer Care Representative Anthem Blue Cross Blue Shield | City, STATE,
  • Provides customer service to applicants regarding status of their application throughout the underwriting process for individual coverage.
  • Provides information to help applicants understand the process and educate them on their coverage options in the event they do not qualify for coverage they applied for, including providing premium rate information.
  • Gathers needed or missing information to complete the underwriting process.
  • Created and generated correspondence for approved/denied applicants.
  • Handles complex inbound calls from applicants regarding application status by providing detailed knowledge of products, eligibility requirements, HIPAA rules, portability and privacy laws.
  • Pursues additional information required for processing the application through contact with applicants, brokers, and providers.
  • Discusses coverage options and rates available to each eligible customer in event of adverse underwriting decisions on product underwritten.
  • Determines if applicants are eligible to proceed with medical underwriting based on non-medical and medical criteria and knowledge of products and eligibility requirements.
  • Reduced assigned inventory to achieve cycle time goals.
  • Meets individual quality and production goals at 120% and above.
  • Perform peer training.
Expected in September 1985 | Some College (Nursing), Louisville, KY GPA:
Expected in June 1985 High School Diploma | Jefferson Community College, Louisville, KY GPA:
Expected in | Western High School, , GPA:
Professional Affiliations
Accounts Receivable, Microsoft Applications, Scheduling appointments, basic, benefits, Billing, Case Management, Clerical, CMS, coaching, clients, customer service, Decision Making, dependable, Detail Oriented, Government, Imaging, Insurance, inventory, Listening, Access, Excel, money, Outlook, Word, neat, organizational, Preparing patient, PeopleSoft, Problem Solving, quality, Recording, Research, routing, Sales, Scanning, self-starter, team player, phone, Time Management, underwriting

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Resume Overview

School Attended

  • Some College (Nursing)
  • Jefferson Community College
  • Western High School

Job Titles Held:

  • Front Office Receptionist
  • Billing Membership Representative II
  • Underwriting Customer Care Representative


  • High School Diploma

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