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

Knowledgeable and dedicated research analyst with extensive experience in the Healthcare/Business Analysis industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.

Skills
  • Written and Verbal communication
  • Organizational Skills
  • Time Management
  • Strong Analytical and Problem Solving Skills
Education
University of Phoenix Little Rock, AR, Expected in 01/2011 Bachelor of Science : Psychology - GPA :
Work History
Bank Of America Corporation - Inforce Response Analyst
Camillus, NY, 07/2015 - Current
  • Daily research and resolution on key issues regarding Inforce group business, identified by external and internal sources, in order to ensure producers/client needs are optimally met.
  • Responsible over large accounts for key clients to include agents/producers, groups/employers as well as group benefit administrators.
  • Research and rapidly resolve client conflicts to prevent loss of key accounts.
  • Led special projects through effective emergency resolution by diminishing obstacles and saving time.
  • Troubleshot problems using advanced problem solving skills for proper actions and expanded improvement initiatives.
  • Collaborated with staff to develop and implement best practices and accomplished all team goals.
  • Performed research into study topics to increase knowledge and ability to provide valuable contributions.
  • Take active role in creating environment of innovation, collaboration, transparency, accountability and trust.
  • Build trust, confidence and goodwill with key customers by understanding their needs and articulating ability to meet clients' needs with our products and services.
  • Used critical thinking to break down problems, evaluate solutions and make decisions
  • Completed all paperwork, recognizing any discrepancies and addressing them in a timely fashion
  • Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting
  • Optimized system and platform performance capabilities in most efficient, practical way possible.
  • Applied honed problem-solving skills to analyze and resolve issues impacting business operations and goal achievement.
  • Mapped current business and operational processes and recommended areas for improvement.
  • Improved business direction by prioritizing customers and implementing changes based on collected feedback.
  • Derived conceptual designs from business objectives to deliver software and applications according to specifications for usability, performance and functionality.
  • Trained and mentored 10 new personnel hired to fulfill various roles.
  • Monitored day-to-day activities of offshore employees, noting areas needing improvement and implementing plans for rectification.
  • Created training documentation and written tests for TCS offshore employees within policy holder services operations.
General Dynamics - Inforce Response Specialist
Healdsburg, CA, 07/2014 - 07/2015
  • Take ownership for working with producers and internal business partners to provide solutions for Inforce eligibility, policy status and claims status.
  • Research and correct items or identify resources required for completing producers requests.
  • Work in partnership with sales, account management teams and administrative departments to analyze, troubleshoot facilitate solutions and resolve account issues, audits and rate or premium discrepancies.
  • Review and make recommendations to resolve issues; identify possible cause and facilitate actions of all necessary parties.
  • Responsible for communicating with all involved parties until issues are resolved or projects completed.
  • Utilize systems, software and other reporting mechanisms (such as EIS, AWD, CK4, BRASS and MS Office products) to create accurate client files.
  • Develop and maintain weekly and monthly reporting on root cause, process analysis steps and process improvement recommendations.
  • Uphold established department service standards as well as maintain confidentiality of information as appropriate.
  • Communicate, on both written and verbal basis, with cross-section of stakeholders including producers, management, and internal departments.
  • Perform projects and other activities as assigned to deliver consistent, exceptional key account customer and internal service.
  • Take active role in creating environment of innovation, collaboration, transparency, accountability and trust Assist TEB producers by promptly answering calls and e-mails directed to our dedicated producer line
  • Build trust, confidence and goodwill with key customers by understanding their needs and articulating ability to meet clients needs with our products and services
  • Assist producers, management and client relationship managers with Inforce eligibility requests, policy status, claims status and other producer requests deemed appropriate for the Inforce Response Specialist team
  • Research and correct items when applicable and identify next steps and resources required for completing producers requests timely
  • Maintain accurate client files, utilizing AWD workflows and EIS Utilize systems, software and other reporting mechanisms (such as EIS, AWD, CK4, BRASS and Microsoft Office products) to keep track of weekly calls, research requests and issue resolution
  • Maintain established department service standards as well as maintains confidentiality of information as appropriate
  • Communicate, on both written and verbal basis, with cross-section of stakeholders including producers, management, and internal departments
  • Perform projects and other activities as assigned to deliver consistent, exceptional key account customer and internal service
  • Other duties as assigned based on divisional needs
  • Conforms with and abides by all regulations, policies, work procedures, instruction, and all safety rules
  • Exhibits regular, reliable, punctual and predictable attendance.
Health Scope Benefits - Senior Claims Analyst
City, STATE, 06/2011 - 06/2014
  • Processing and evaluating medical and dental claims
  • Obtaining information via telephone as well as by hard copy for claim processing
  • Prioritization of individual work flow associated with case assignments
  • Establishing and maintain professional rapport with clients and providers (physicians and hospitals)
  • Maintaining confidentiality and assuring accuracy of private healthcare documentation
  • Meet and/or discuss with members, clients and providers any issues relating to claim administration approximately 25% of the time
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims
  • Investigated and processed health insurance claims for policyholders
Arkansas Blue Cross Blue Shield - Customer Service Representative
City, STATE, 01/2006 - 06/2011
  • Calculated discounts and any promotions as applicable to purchase price.
  • Provided accurate and appropriate information in response to customer inquiries Assist BCBS members, prospective clients, and corporate vendors with health insurance inquiries.
  • Resolved insurance claims/conflicts Negotiation as needed with vendors and demonstrated professionalism in workplace via communication and team leadership Exhibited knowledge and proficiency of BCBS nature and scope of business Established effective communication with faculty and staff Developed marketing skills and promoted suitable products to group administrators accordingly
  • Processed pharmacy health claims
  • Micro Service Representative for My Tracker Program Mentor/trainer for new employees.
  • Addressed customer service inquiries in timely and accurate fashion.
  • Maintained up-to-date records at all times.
  • Developed effective relationships with all call center departments through clear communication.
  • Worked with upper management to ensure appropriate changes were made to improve customer satisfaction.
  • Built customer loyalty by placing follow-up calls for customers who reported product issues.
  • Formulated and enforced Service Center policies, procedures and quality assurance measures.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Responded to customer requests for products, services and company information.
  • Provided primary customer support to internal and external customers.
  • Answered constant flow of customer calls with minimal wait times.
  • Consulted with outside parties to resolve discrepancies and create effective solutions.
  • Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Developed community reputation through commitment to customer satisfaction and strong client relationships.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Disclaimer

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

How this resume score
could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

92Good

resume Strength

  • Formatting
  • Length
  • Personalization
  • Strong Summary
  • Target Job
  • Typos

Resume Overview

School Attended

  • University of Phoenix

Job Titles Held:

  • Inforce Response Analyst
  • Inforce Response Specialist
  • Senior Claims Analyst
  • Customer Service Representative

Degrees

  • Bachelor of Science

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in: