Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,

Talented healthcare Insurance Specialist ready to leverage in any health-care related environment with extensive knowledge of the healthcare industry and a deep understanding of medical terminology, and insurance. Enthusiastic about growth and developmental skills, insurance account management with excellent planning and problem solving abilities. Offering over 15 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.

  • Claim validity determination
  • Insurance claims management
  • Medical terminology
  • Reporting abilities
  • Documentation skills
  • Account management expertise
  • Regulatory compliance understanding
  • Problem resolution
  • Reliable and trustworthy
  • Analytical
  • Knowledgeable healthcare insurance claims matters
  • Telephone etiquette
  • Recordkeeping and data input
  • Authorizations knowledge
  • People skills
  • Friendly, positive attitude
  • Benefits interpretation
  • Verbal and written communication
  • Call center operations
  • Quality assurance controls
  • Call control skills
  • Providing customer support
  • Quality assurance optimization
  • Resolving issues
  • Payment processing
  • Call documentation skills
  • Professional telephone voice
  • Documentation research
  • Coverage determination
  • MS Office
  • Multitasking
  • Computer skills
03/2020 to 05/2021 Medical Claims Representative Concentra | Cleveland, OH,
  • Inputted data into the system, maintaining accuracy of provider coding information and reported services.
  • Based payment or denials of medical claims upon well-established criteria for claims processing.
  • Documented file notes clearly and concisely.
  • Sent clinical request and missing information letters to obtain incomplete information.
  • Reviewed standard contract benefits to process pending claims for benefits.
  • Reviewed claims for accuracy before re-submitting for billing.
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
  • Updated account status records and collection efforts.
  • Updated company's database daily with any new details regarding collections and activity on delinquent accounts.
  • Accepted and processed customer payments and applied toward account balances.
  • Methodically resolved active claims by analyzing possible solutions.
  • Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
  • Exceeded customer satisfaction by finding creative solutions to problems.
  • Analyzed information from interviews, educational, and medical records, consultation with other professionals and diagnostic evaluations to assess clients' abilities, needs and eligibility for services.
  • Effectively coordinated all communications between patients, billing personnel and insurance carriers.
  • Provided quick turnaround time when patients called with questions regarding pending or unpaid claims.
06/2017 to 09/2017 Medical Clinic Manager Treasure Valley Gastroenterology | City, STATE,
  • Developed relationships with healthcare providers to sustain strong referral pipeline.
  • Managed routine operations and clinical projects, including setting targets and performance standards in accordance with company requirements
  • Completed detailed and efficient assessments of each patient to support development of multidisciplinary treatment plans.
  • Works in conjunction with the business office to ensure appropriate, accurate and timely financial reimbursement for all services rendered.
  • Manages, performs and/or assists with patient registration or patient processing, scheduling Medical and Physical Therapy Services, check in/out, and case management per referrals or authorizations.
  • Communicated with patients with compassion while keeping medical information private.
  • Assumes all medical records custodian responsibilities in accordance with policy and procedures
05/2013 to 06/2016 Clinical Authorization/Medical Claims Specialist United Healthcare | City, STATE,
  • Inputted data into the system, maintaining accuracy of provider coding information and reported services.
  • Evaluated pending authorizations to identify and resolve problems blocking auto-adjudication.
  • Provided assistance to plan participants by explaining benefits information to ensure educated selections.
  • Reviewed employee enrollments to verify accuracy,
  • Handled billing related activities focused on medical specialties.
  • Followed specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand medical terminology.
  • Verified that patients had proper insurance coverage prior to any procedures or appointment scheduling.
  • Examined claims, records and procedures to grant approval of coverage.
  • Addressed, documented and responded to incoming correspondences to address client queries.
  • Gathered information to file appeals for denials of services and minimized inaccuracies by maintaining accurate records of approvals.
  • Answered daily phone calls pre call center requirements.
07/1990 to 05/2012 Medical Practice Manager Robert Nelson M.D.P.A | City, State,
  • Supervised daily operations of the physician practice, overseeing staff members.
  • Checked entire office and waiting areas regularly to provide clean and organized surroundings.
  • Coordinated financial operations, including budgeting, accounting, expenses and financial reporting.
  • Employed active listening and interpersonal talents to effectively interact with various individuals, including physicians, patients and fellow employees.
  • Developed and implemented policies and procedures per facility.
  • Created onboarding program for new staff members, training in customer service and billing procedures.
  • Complied with OSHA and HIPAA regulations.
  • Ordered all supplies needed and kept tabs on inventory levels.
  • Ensure provider enrollment per NPI and provider billing tax ID for billing purposes, assisted in contract negotiating for accuracy with various insurance companies while resolving in-network management issues
  • Assistant with Prescription, DME, OT and other pre-authorization services.
Education and Training
Expected in 10/2017 BBA | Bachelor of Healthcare Administration American InterContinental University, Schaumburg, IL GPA:
Expected in 11/2012 Associate of Arts | Business Administration American InterContinental University, Schaumburg, IL GPA:

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School Attended

  • American InterContinental University
  • American InterContinental University

Job Titles Held:

  • Medical Claims Representative
  • Medical Clinic Manager
  • Clinical Authorization/Medical Claims Specialist
  • Medical Practice Manager


  • BBA
  • Associate of Arts

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