Insurance Claims Processor resume example with 12+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,
Professional Summary
Professional customer service rep offering: ten years of experience and providing customer support in busy call center environments for travel, public utility and health insurance industry. An unwavering commitment to customer service, with the ability to build productive relationships, resolve complex issues and win customer loyalty, by listen attentively, while resolving Customer problems creatively, and use tact and diplomacy to find common ground and achieve win-win outcomes.
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Work History
09/2013 to 01/2018 Insurance Claims processor Aaa Of Southern California | Saint Peters, PA,
  • Managed a wide variety of customer service and administrative tasks to resolve customer issues efficiently in a timely manner.
  • Answered an average of 150 calls per day by addressing customer inquiries, solving problems and providing new product information.
  • Built trust with customers and provided quality results in an efficient manner.
  • Answered a wide array of questions and educate customer's simple issues, self-resolutions and offer value added services.
  • In-depth understanding of insurance policies laws and regulations.
  • Processed claims for Verizon wireless customer replaced their device and made sure it was delivered in a timely manner.
  • Answered customer questions regarding deductibles.
  • Reviewed new filed new claims provided current status of claim and to processed payments for claims Reported claims involving potential and suspected fraudulent activities.
  • Tracked the progress of all outstanding insurance claims.
  • Reported policy changes and company conditions affecting customer satisfaction.
11/2007 to 02/2010 Travel Agent Consulate Health Care | Bushnell, FL,
  • Researched, planned and executed customized travel experiences, through booking domestic and international flights, car and/or hotel travel accommodations.
  • Always put the Card members experience at the forefront of everything while reinforcing the WOW and winning their Customer loyalty.
  • Consulted with Card Members and recommended relevant products and services that were perfectly tailored to their needs.
  • Stayed on top of the industry trends and provided knowledgeable advice and sold products and services with confidence to card members agents.
  • Demonstrated consistent ability to close sales and achieve high productivity.
  • Maintained high customer satisfaction ratings for services rendered.
11/2003 to 08/2007 Admissions Coordinator Aaa Of Southern California | San Clemente, CA,
  • Provided the highest level of confidentiality due to referrals from branches, physicians, patients and third party payers.
  • Verified benefits including prior authorization requirements as well as obtained medical information and records.
  • Gathered physician information and maintenance of corporate physician databases.
  • Complied applicable laws, regulations and ensured facility adhered to Medicare and Medicaid regulations.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.
  • Determined prior authorizations for medication and outpatient procedures.
  • Posted and adjusted payments from insurance companies.
  • Examined patients insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
  • Researched questions and concerns from providers and provided detailed responses.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Answered incoming phone calls and addressed questions from customers and healthcare providers.
  • Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
  • Resolved non-routine issues like third party billing, computer system and customer service issues.
  • Reviewed and verified customer information and insurance provider information.
08/2001 to 07/2003 Travel Agent Apple Vacations | City, STATE,
  • Developed and maintained outstanding relationships with clients and exceeded their expectations for customer service while securing their travel arrangements.
  • Conversed with customers to determine destinations, modes of transportation, travel dates, financial considerations, and accommodations required to book transportation and hotel reservations.
  • Maintained efficient computer planning and organizational skills to describe, arrange and sell itinerary tour packages in addition to promoting travel incentives offered by various travel carriers.
  • Booked transportation, make hotel and resorts reservations and collected payments and fees.
  • Dealt with occurring travel problems, complaints and refunds.
  • Provided customers with brochures and publications containing travel information, such as local customs, points of interest, or foreign country regulations.
  • Met or exceeded service and quality standards every review period.
  • Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.
  • Managed high call volume with tact and professionalism.
  • Defused volatile customer situations calmly and courteously.
  • Resolved service, pricing and technical problems for customers by asking clear and specific questions.
Expected in 2011 Bachelor of Science | Human Services Shorter University, Rome, GA GPA:
Human Services
Expected in 2010 Associate of Arts | Business Administration Benedictine University & College, Lisle, IL GPA:
Business Administration
Accounting, administrative, benefits, billing, book, brochures, Budgeting, call center, oral communication, Consulting, clients, customer satisfaction, customer service, databases, Decision Making, documentation, fast, financial, insurance, listening, Multitasking, nursing, organizational skills, policies, pricing, Problem Solving, progress, publications, quality, sales, Self-motivated, Team Player, phone, transportation, travel arrangements, Written

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Resume Overview

School Attended

  • Shorter University
  • Benedictine University & College

Job Titles Held:

  • Insurance Claims processor
  • Travel Agent
  • Admissions Coordinator
  • Travel Agent


  • Bachelor of Science
  • Associate of Arts

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