medical claims specialist resume example with 20+ years of experience
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Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously. Experienced Medical Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 10 years of experience and willingness to take on any challenge. Collaborative Insurance Verification Specialist with proven success building patient rapport and preserving data integrity. Smart, reliable and possessing extensive Medicaid and non-Medicaid benefits knowledge. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Astute Call Center professional offering polished communication skills. Brings excellent organizational skills and talent for overcoming customer objections. Self-motivated and true team player. Dedicated Customer Service professional with knowledge of service delivery and proven multitasking abilities. Committed to maintaining professional relationships to increase profitability and drive business results. Passionate about promoting lasting customer satisfaction by delivering quality service and unparalleled support. Proficient in customer service best practices and related options. Customer Service Representative bringing top-notch skills in oral and written communication, active listening, and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty. Focused customer relations professional skilled in lead generation, customer relationship development and sales. Accomplished in providing unsurpassed support to demanding customers. Offering experience in related roles, as well as passion for improving service delivery, enhancing knowledge and exceeding expectations. Retail professional with extensive knowledge of fashion industry and current trends. Enjoys helping customers find stylish and affordable clothing and accessories. Accomplished Sales Representative with solid sales history and in-depth sales experience. Diligent and professional with expertise in conducting market analysis and recognizing trends within territories. Achieved industry-leading customer and revenue growth by leveraging top-notch abilities in networking and lead development. Demonstrated success in converting prospects into customers, servicing accounts and maintaining consistent sales levels. Skilled relationship-builder, communicator and multitasker.
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- Followed up on potentially fraudulent claims initiated by claims representatives.
- Managed large volume of medical claims on daily basis.
- Submitted electronic/paper claims documentation for timely filing.
- Evaluated accuracy and quality of data entered into agency management system.
- Paid or denied medical claims based upon established claims processing criteria.
- Reviewed provider coding information to report services and verify correctness.
- Reported policy changes and company conditions affecting customer satisfaction.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Troubleshot and resolved online ordering issues and concerns to promote seamless ordering process for customers.
- Answered live online chats to give quick answers and solve problems faster.
- Provided empathetic and amiable communications to callers in stressful situations to support constructive outcomes and satisfactory resolutions.
- Resolved minor to moderate technology faults, supporting constant availability and consistent performance.
- Maintained functional and productive workspaces, prioritizing quiet atmospheres for call quality and clarity.
- Applied creative thinking to client questions and concerns absent from scenario-based response manuals.
- Answered inbound customer queries according to internal policies, meeting concerns and resolving questions.
- Attended virtual department meetings, contributing to ongoing improvement initiatives and addressing emerging performance concerns.
- Conducted quality assurance reviews of website to maintain accuracy of online booking tool.
- Processed orders, monitored back-orders, invoiced and followed shipping procedures to expedite online ordering process.
- Developed and maintained knowledge of evolving products and services to accurately answer questions and make recommendations based on customer needs.
- Maintained positive and professional attitude toward customers to foster positive experiences resulting in repeat online purchases.
- Resolved customer complaints by determining cause of problem, selecting best solution and expediting correction or adjustment.
- Followed-up with online price quotes via email and phone to answer questions and close sales.
- Assisted clients with product questions to facilitate online ordering process.
- Provided primary customer support to internal and external customers.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Consulted with outside parties to resolve discrepancies and create expert solutions.
- Recommended products to customers, thoroughly explaining details.
- Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
- Answered constant flow of customer calls with minimal wait times.
- Cultivated customer loyalty, promoted repeat business and improved sales.
- Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.
- Collected customer feedback and made process changes to exceed customer satisfaction goals.
- Assisted customers with setting appointments, special order requests, and arranging merchandise pick-up.
- Developed community reputation through commitment to customer satisfaction and strong client relationships.
- Provided information regarding charge accounts and loyalty programs.
- Fielded customer questions regarding available merchandise, sales, current prices and upcoming company changes.
- Resolved associate, tool and service delivery issues revealed by statistical reports.
- Followed-through on all critical inter-departmental escalations to increase customer retention rates.
- Handled over 80 calls per shift signing up new customers, retrieving customer data, presenting relevant product information and cancelling services.
- Showcased product features to customers and discussed technical details to overcome objections and lock in sales.
- Visited customer locations to evaluate requirements, demonstrate product offerings and propose strategic solutions for diverse needs.
- Computed total costs and profit requirements for customer sales to provide accurate pricing.
- Provided first-rate service to all customers and potential customers.
- Supported retail distributors, dealers and customers through in-person and telephone support.
- Built rapport with customers and assessed needs to make product recommendations and upsell.
- Drafted, finalized and submitted paperwork to complete sales.
- Accepted and processed customer payments and balanced receipts and cash.
- Checked pricing, scanned items, applied discounts and printed receipts to ring up customers.
- Helped customers complete purchases, locate items and join reward programs.
- Informed customers of current store promotions to encourage additional sales purchases.
- Used POS system to process sales, returns, online orders and gift card activations.
- Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions and common goals.
- Controlled costs and optimized spending via restructuring of budgets for labor, capital assets, inventory purchasing and technology upgrades.
- Improved operational planning and business frameworks to enhance resource utilization and reduce waste.
- Established and updated work schedules to account for changing staff levels and expected workloads.
- Managed budgets, appointment scheduling, employee and event itineraries and accounts to improve productivity initiatives.
- Established workflow processes, monitored daily productivity and implemented modifications to improve the overall performance of personnel.
- Aggregated and analyzed data related to administrative costs to prepare budgets for corporate-level management.
- Compared vendor prices and negotiated for optimal savings.
- Managed office operations while scheduling appointments for department managers.
- Prepared meeting materials and took clear notes to distribute to stakeholders.
- Initiated timely project management within budget constraints for multi-faceted problems concerning executive leaders.
- Established and developed a strong administrative team by delivering ongoing coaching and motivation and fostering career advancement.
- Optimized organizational systems for payment collections, AP/AR, deposits, and recordkeeping.
- Partnered with marketing teams to provide insight about development of product pitches, boosting sales projections 20%
- Resolved customer complaints and maintained clean and tidy checkout area.
- Maintained customer satisfaction with quick and professional handling of product returns.
- Monitored self-checkout systems and provided assistance or intervention where required.
- Completed file maintenance log for price discrepancies.
- Counted money in drawers at beginning and end of each shift.
- Sold lottery tickets and fish and game licenses.
- Processed accurate and efficient sales and return transactions to facilitate customer satisfaction.
- Enabled customers to feel welcomed, important and appreciated by answering questions about products sold throughout store.
- Maintained reports of transactions and greeted customers when entering and leaving establishment.
- Verified deactivation and removal of Electronic Article Surveillance Tags from products at point of sale.
- Handled approximately daily credit and cash transactions for customers with accuracy and speed.
- Conducted inventory counts by adding each item in stock and documenting in computer system.
- Learned duties for various positions and provided backup at key times.
- Checked identification for proof-of-age for alcohol and tobacco sales.
- Used POS system to enter orders, process payments and issue receipts.
- Maintained current knowledge of store promotions and highlighted sales to customers.
- Reconciled cash drawer at start and end of each shift, accounting for errors and resolving discrepancies.
- Set up new sales displays each week.
- Performed cash, card and check transactions to complete customer purchases.
- Operated cash register to record transactions accurately and efficiently.
- Delivered excellent customer service, resulting in consistent 100% customer satisfaction rating
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
- Provided primary customer support to internal and external customers
- Leveraged sales expertise to promote products and capitalized on upsell opportunities
- Provided information regarding charge accounts and loyalty programs
- Offered advice and assistance to customers, paying attention to special needs or wants
- Effective liaison between customers and internal departments
- Optimized customer support by establishing collaborative service environment
Hartsville High School - Hartsville, SC
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Resume Overview
School Attended
- Hartsville High School
Job Titles Held:
- Medical Claims Specialist
- Sales Specialist
- Customer Service Representative
Degrees
- High School Diploma
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