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health insurance specialist resume example with 11+ years of experience

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Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Summary

Hi, my name is Jessica. Im currently working as a health insurance specialist at South Texas Radiology Group, who is also the billing company of South Texas Radiology Imaging Centers. My job includes a lot of critical thinking, and problem solving, with very much detail orientation in the world of health insurance. I file appeals for denied medical claims, resolve billing descrepancies etc. Im a very hard working and well disciplined person.

Skills
  • MS Office
  • Administrative support
  • Team building
  • Health Insurance Policy knowledge Specially BCBS and Aetna

Advance clinical skills to understand medical terminology and code for different injuries, conditions, or diseases.

  • Skilled communicator
  • Great interpersonal skills to interact with carrier representatives, patients, and physicians.
  • Great Analytical skills for any billing errors and make the necessary modifications.
  • Very detail-oriented with good organizational skill.
  • Vast knowledge in electronic health records, coding software, email, and databases.
Experience
12/2015 to Current Health Insurance Specialist Oak Street Health Inc. | Tempe, AZ,
  • Resolved [Type] issues quickly through meticulous research, [Skill] and [Skill].
  • Provided quick turnaround time when customers called with questions, usually within [Number] hours.
  • Streamlined operational efficiencies by researching problems and delivering speedy issues resolution.
  • Reduced financial discrepancies by accurately resolving billing issues while processing applications and cancellations.
  • Skillfully and patiently explained coverage options to potential policyholders, answering any questions or concerns.
  • Developed cost-savings and new solutions to existing problems through persistent research and innovation.
  • Achieved mutual agreements and cleared up miscommunications by working with all parties to reach win-win solutions.
  • Earned good attendance record and built reputation for being on time and ready to work.
  • Escalated identified risk issues, challenges and trends to senior management and delivered risk-related documents for audit and regulatory exams.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
12/2011 to 12/2015 Online English Teacher Education First | Pasadena, CA,
  • Used pre-selected lesson plans to instruct students in English conversation and grammar.
  • Customized instructional plans to meet individual student skill level and learning style.
  • Updated documentation with speed and accuracy.
  • Completed all scheduled teaching appointments and worked as many as [Number] hours per week.
  • Developed and implemented interesting and interactive learning media to increase student understanding of course materials.
  • Taught English classes to students of various levels.
  • Evaluated students' comprehension of lessons through relevant test questions.
  • Created exciting lessons on course material to educate and engage students in classroom.
  • Created lesson plans to teach English language to non-native speakers.
  • Attended and participated in staff meetings to learn new teaching strategies and brainstorm ideas to improve classroom presentations.
  • Coached students, offering one-on-one tutoring to improve linguistics and pronunciation.
11/2011 to 09/2012 Registered Nurse Crozer-Keystone Health System | Drexel Hill, PA,
  • Administered medications, tracked dosages and documented patient conditions.
  • Educated patients and families on treatment strategies and at-home care.
  • Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
  • Developed and adapted individualized treatment plans according to patient recovery goals.
  • Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services.
  • Administered oral, intramuscular and IV medications to patients and monitored responses.
  • Oversaw patient admission and discharge processes to coordinate efficient movements and related paperwork.
07/2009 to 10/2011 Health Insurance Help Desk Hinduja Global Solutions - Aetna Account | City, STATE,
  • Escalated identified risk issues, challenges and trends to senior management and delivered risk-related documents for audit and regulatory exams.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
  • Achieved mutual agreements and cleared up miscommunications by working with all parties to reach win-win solutions.
  • Earned good attendance record and built reputation for being on time and ready to work.
  • Correlated and recorded data obtained during surgical procedure, including maintaining departmental records, reports and charts.
Education and Training
Expected in 08/2014 to to Associate of Science | Medical Billing And Coding United States Career Institute, Fort Collins, CO GPA:
Expected in 10/2008 to to Bachelor of Arts | Nursing Central Philippine University, Iloilo,Philippines, PH GPA:

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Resume Overview

School Attended

  • United States Career Institute
  • Central Philippine University

Job Titles Held:

  • Health Insurance Specialist
  • Online English Teacher
  • Registered Nurse
  • Health Insurance Help Desk

Degrees

  • Associate of Science
  • Bachelor of Arts

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