medical insurance specialist resume example with 7+ years of experience

(555) 432-1000,
, , 100 Montgomery St. 10th Floor
Professional Summary

Results-driven professional with exceptional drive for helping employers recruit, develop and retain qualified candidates. Skilled at partnering with management teams to build employee-centric cultures promoting positive morale and optimizing productivity. Motivating and positive with excellent interpersonal, coaching and communication skills. Builds rapport at all levels and resolves issues quickly. Organized planner with wonderful team leadership and program management abilities.

  • Insurance claims processing
  • Scrupulous records management
  • Medical terms and procedure knowledge
  • Supervision
  • Account management
  • Troubleshooting
  • Thorough claims reviews
  • Health insurance industry knowledge
  • Data security procedures
Strayer University Washington, DC Expected in 05/2025 Bachelors : Human Resource Management - GPA :
  • Coursework in Organizational theory and design, Legal issues in HR Management, and Compensation and Benefits
Work History
Us Oncology, Inc. - Medical Insurance Specialist
Paris, TX, 12/2019 - Current
  • Managed large volume of medical claims on daily basis.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Tracked all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Communicated verification and authorization status updates with various departments to facilitate decision-making for patient admissions and insurance coverage.
Ariens - Inside Sales Representative
Milwaukee, WI, 12/2018 - 12/2019
  • 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.
  • Wrote sales contracts for orders obtained and submitted orders for processing.
  • Developed and deepened customer relationships to drive revenue growth.
  • Emphasized product features based on analysis of customers' needs.
  • Established fair pricing structures and finalized contracts to complete purchase agreements with customers.
  • Set up new accounts, established customer credit, and set up payment methods.
  • Followed up with customers after completed sales to assess satisfaction and resolve any technical or service concerns.
  • Determined needs, delivered solutions and overcame objections through consultative selling skills.
  • Collaborated with vendor representatives and company customers to set up optimal delivery schedules.
  • Computed total costs and profit requirements for customer sales to provide accurate pricing.
  • Prioritized daily workflows, including all inbound calls, quotes and sales-related inquiries.
Cxre - Telesales Representative
Porter, TX, 02/2017 - 12/2018
  • Established excellent sales ability and strong interpersonal skills with confident and persuasive approach.
  • Opened new accounts and documented personal, demographic and payment information in system.
  • Made average of 70 outbound and inbound calls per day.
  • Troubleshot any issues and escalated issues to proper department.
  • Explained product prices and packages as well as answered questions and addressed concerns of customers.
  • Provided information about available products and services including membership details and purchase advantages.
  • Skilled at client management software and computer dialing.
Getgo - Customer Service Supervisor
Canfield, OH, 04/2016 - 12/2018
  • Helped employees with day-to-day work and complex problems by applying motivational and analytical strategies.
  • Led process improvement and problem-solving efforts to create standard procedures and escalation policy for customer support team.
  • Conferred with sales teams and team leaders to communicate targets, boost revenue and improve promotional strategies.
  • Prepared reports to assist business leaders with key decision making and strategic operational planning.
  • Exceeded team goals and collaborated with staff members to implement customer service initiatives.
  • Increased efficiency and team productivity by promoting operational best practices.
  • Coached team members to deliver hospitable, professional service while adhering to set service models.
  • Supervised 6 Sales Representatives in providing excellent customer service to callers requiring assistance for technical and escalation issues.
  • Monitored metrics and developed actionable insights to improve efficiency and performance.
  • Initiated investigations into complex or sensitive complaints, identifying solutions swiftly and to customer satisfaction.
  • Executed on-time and under-budget project management on complex issues while updating customers on technician availability.
  • Established and updated work schedules to account for changing staff levels and expected workloads.
  • Researched and corrected regular, advanced and long-standing customer concerns to promote company loyalty.
  • Compiled and analyzed customer feedback data to develop new strategies and corrective action.
  • Assessed and authenticated customer exchanges, voids and returns.
  • Conducted training and mentored team members to promote productivity, accuracy and commitment to friendly service.

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Resume Overview

School Attended

  • Strayer University

Job Titles Held:

  • Medical Insurance Specialist
  • Inside Sales Representative
  • Telesales Representative
  • Customer Service Supervisor


  • Bachelors

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