Inquiry Resolution Specialist Resume Example

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Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Career Focus
Seeking a responsible position as a Dispute Coordinator with an organization that offers an opportunity towards professional growth and development
Knowledge & core Competencies
  • Quality Assurance, reviewed written correspondence (35-50) letters per day for compliance, verifying appropriate state language, proper documentation were added.
  • Verify all disputes were addressed to responsible party.
  • Reviewed provider files for appropriate documentation required for the credentialing process. Coordinated credentialing and re-credentialing applications.  
  • Performed primary source verification and request information from appropriate data banks. Interfacing between providers and hospital staffs to collect required information.
  •  Collect and maintain files in relation to credentialing of network providers, including application, contracts, current physician licenses, DEA licenses, malpractice insurance, board certifications and other pertinent forms.
  • Prepare documents for Credentialing Committee review. Submit applications to manager, medical director and Credentialing Committee for review.
  • Extensive call center representative experience. Strong familiarity of product knowledge to inform customers.
Professional Experience
07/2017 to Inquiry Resolution Specialist Prometric | Tulsa, OK,
  • Reviewed written correspondence to responsible parties, facilities credit reporting agencies ensuring compliance with all federal and state laws, regulations and reporting, procedural requirements.
  • Inappropriate/incomplete insurance billing
  • Spousal parental liability
  • Account explanation
  • Health Insurance Portability and Accountability Act (HIPAA)Fair Debt Collection Practices Act (FDCPA)Fair Collection Practices Act (FCRA)
07/2016 to 07/2017 Customer Service Representative Jefferson Health | Montgomery County, PA,
  • Educate members on the benefits of using Experian's membership products. Updated consumer information.
  • Provided trouble shooting, resolved log on issues, Billing concerns, updated credit cards, applied payments.
  • Tier 1 Disputes agent, educated consumer on dispute process. Pertinent listing to consumer  inquiery to determine transferring to tier 2, fraud or mixed agents.
  • Educated consumer about their credit scores and assisted consumer with adding fraud alerts, credit freezes.
01/2012 to 02/2016 Provider Credentialing Specialist Avidxchange | Birmingham, AL,
  • Responsible for the the completion of 50 initial/reappointment applications per week.
  • Reviewed initial applications within 10 days (Illinois,Texas) for completeness.
  • Primary source verification of licensure, malpractice, hospital privileges.
  • Contacted providers via phone,email,fax for missing,information and documents.Maintained daily communication with providers, providing status updates.
08/2011 to 11/2011 Customer Service representative, North Texas Tollway Monster Beverage 1990 Corporation | San Juan, PR,
  • Averaged 40 calls per day, resolving billing issues, and violations with one call resolution.
  • Educated all customers selling and promoting the North Texas Toll way and its services. This was a temporary position through Pride Staff.
2011 to 06/2011 Customer Care Representative Homeland HealthCare | City, STATE,
  • Provided a comprehensive explanation of their Indemnity insurance plan.
  • Delivered excellent customer service assisting members to utilize all free services associated with the plan.
  • Detailed benefits of indemnity plans to both policy holders and medical staff personal.
  • Resolved basic claims issues, concerning billing, payments.
05/2010 to 2011 Customer Service Representative, G.E. Money Bank Temporary Position | City, STATE,
  • Provided accurate and appropriate information in response to customer inquiries exclusively for J.C. Penny card holders.
  • Assisted consumer with billing inquiries, payments and issuing of new cards. 
  • Took payments, made payment arrangements and credit increase inquierys.
08/2003 to 01/2010 Consumer Relations Representative Assurant Solutions | City, STATE,
  • Provided outstanding technical support over the phone to Circuit City Customers.
  • Basic hard drive trouble shooting and software maintenance. Promoted to 2nd level support in 6 months.
  • Resolving 30 tickets a day. Collaborated with patiently with computer users, trouble shooting and resolving connectivity peripheral issues.
  • Oversaw all escalations, taking full ownership of critical service calls.
  • Assurant Solutions moved over to supporting G.E. Warranties in which I was a liaison between the customer and vender, service technicians.
  • Created and managed tickets maintaining a close relationship with the customer till resolution.
08/2015 to 08/2016 Part time Service Desk Associate Home Depot | City, STATE,
  • Pro Desk Cashier. Also worked extensively in the Garden Dept, assisted with merchandise returns at service desk.
  • Promoted to the Service Desk. Completed truck and carpet cleaner rentals. Completed advanced returns and merchandise orders(in store, online) pulled orders and merchandise pickup.
  • Worked at Pro Desk placing orders for contractors, phone sales. Service desk was also utilized for Pro Desk- after hours. Followed up with customers, returning and making phone calls.
07/2018 to Current Benefits & claims Representative United HealthCare | City, STATE,
  • Provide one call resolution to claims issues, directing pertinent issue to correct department for process. Answer billing concerns with positivity.
  • Quote benefits with explanations as inquired to providers and members.
  • Advise members with school eligibilty and enrollment questions. Assist with enrollment as needed.
Expected in 2014 Course Certificate | Medical Staff Services El Centro College, Dallas, TX GPA:
Medical Staff Services credentialing course.
Expected in 2001 Certificate | MicroSoft Applications Southern Methodist University, Plano, TX GPA:

Microsoft Certified Systems Engineer, Southern Methodist University - Plano, TX, U S A The study of Microsoft's infrastructures, installing, configuring and administrating Microsoft systems.

  • Skilled in prioritizing task with excellent multitasking and problem solving skills.
  • Ability to perform task under pressure and work in a fast paced dynamic environment.
  • Possess strong analytical, communicational and organizational skills.
  • Familiar with Microsoft office  applications and administrative procedures.
  • Highly creative thinking and customer service skills.
  • ​Excellent time management skills. Attention to detail.

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Resume Strength

  • Length
  • Personalization
  • Strong Summary
  • Target Job

Resume Overview

School Attended
  • El Centro College
  • Southern Methodist University
Job Titles Held:
  • Inquiry Resolution Specialist
  • Customer Service Representative
  • Provider Credentialing Specialist
  • Customer Service representative, North Texas Tollway
  • Customer Care Representative
  • Customer Service Representative, G.E. Money Bank
  • Consumer Relations Representative
  • Part time Service Desk Associate
  • Benefits & claims Representative
  • Course Certificate
  • Certificate

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