inquiry resolution specialist resume example with 16 years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
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
Inquiry Resolution Specialist, 07/2017 -
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)
Customer Service Representative, 07/2016 - 07/2017
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.
Provider Credentialing Specialist, 01/2012 - 02/2016
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.
Customer Service representative, North Texas Tollway, 08/2011 - 11/2011
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.
Customer Care Representative, 2011 - 06/2011
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.
Customer Service Representative, G.E. Money Bank, 05/2010 - 2011
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.
Consumer Relations Representative, 08/2003 - 01/2010
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.
Part time Service Desk Associate, 08/2015 - 08/2016
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.
Benefits & claims Representative, 07/2018 - Current
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.
Course Certificate: Medical Staff Services, Expected in 2014
El Centro College - Dallas, TX
Status -
Medical Staff Services credentialing course.
Certificate: MicroSoft Applications, Expected in 2001
Southern Methodist University - Plano, TX
Status -

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 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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