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JC
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Professional Summary

Claims Customer Service Rep with over 20 years of successful experience in Data Entry, Claims, and Sales Skills. Recognized consistently for performance excellence and contributions to success of Companies in Multiple industries. Strengths in Customer Retention and Multi tasking , Fast learner, Team Player and Highly Motivated Individual.

Skills
  • Health insurance industry knowledge

  • Medical terms and procedure knowledge

  • Thorough claims reviews

  • Telephone etiquette

  • Knowledgeable in MS Word, MS Excel, Power Point, Outlook, MS Teams, Avaya Phone System

  • Data security procedures

  • Insurance claims processing

  • Reporting skills

  • Documentation abilities

  • Supervision

  • Basic math

  • Leadership

  • Multitasking abilities

  • Teamwork

  • Computer proficiency

Skills

Health insurance industry knowledge

:

Medical terms and procedure knowledge

:

Thorough claims reviews

:

Telephone etiquette

:

Knowledgeable in MS Word, MS Excel, Power Point, Outlook, MS Teams, Avaya Phone System

:

Data security procedures

:

Insurance claims processing

:

Reporting skills

:

Documentation abilities

:

Supervision

:

Basic math

:

Leadership

:

Multitasking abilities

:

Teamwork

:

Computer proficiency

:
Work History
09/2019 to Current Medicare AB Claims/ DME Claims Customer ServiceRep Agency Revolution | Pleasant Grove, UT,
  • Reviewed provider coding information to report services and verify correctness. Ordered Medicare cards. Advised how to apply for Medicare.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Explained how to Apply for Medicaid, LIS and Extra Help paying for Prescription Drug Plans.
  • Followed up on potentially fraudulent claims initiated by claims representatives. Explained IRMAA and Late Enrollment Penalties.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Coordinated with contracting department to resolve payer issues.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Enrolled Beneficiaries in Medicare Advantage Plans and Drug Plans. Explained Coordination of Benefits and claims crossover to members.
  • Documenting phone calls, performing escalations to Advanced Resolution Center, Taking Complaints regarding Medicare Advantage plans and drug plans
07/2017 to 08/2019 Charge Point Driver Support Rep ChargePoint | City, STATE,

Taking Inbound calls from Electric Vehicle Owners and providing assistance releasing locked stations so Customers can charge their vehicles.

Assisting customers with finding stations and giving driving directions.

Explaining various sales incentive programs being offered by Toyota, Nissan, BMW etc. and educating customers on how to apply for these programs.

Educating customers on how to sign up for Charge Point via the Website or Mobile App and how to use the App.

Assisting customers on how to set up their Home Charging Stations and how to link them to the Charge Point Website.

Explaining Pricing Policies at individual stations throughout the USA and Canada as stations are individually owned and pricing varies for the over 40,000 stations involved.

Processing Refunds and explaining Refund Policy

03/2016 to 07/2017 Small Business Sales and Customer Service Rep CenturyLink | City, STATE,
  • Collaborated with current and potential small businesses extensively to understand needs before proposing specific solutions.
  • Attained deep and thorough knowledge of company's products and solutions to help accomplish mutual success and partnership between buyer and seller.
  • Provided sales forecasts within 75% accuracy each quarter and each year for long-term strategic planning.
  • Developed and managed strong and growing pipelines of prospective small business customers.
  • Reached average of 90% of sales goals each year.
  • Achieved sales among top 10% of salespeople in company
  • Recorded and maintained sales prospect and sales data continually and accurately within various customer relationship management systems.
  • Mastered and constantly improved in sales techniques, including prospecting, proposal, exceptions, closing, follow-up and upsell.
  • Served customers with knowledgeable, friendly support at every stage of shopping and purchasing.
  • Trained new employees on customer service, money handling and organizing strategies.
  • Informed customers of promotions to increase sales productivity and volume.
  • Collaborated with managers to provide customer feedback and recommend operational changes to meet emerging trends.
  • Greeted customers and offered assistance with selecting merchandise, finding accessories and completing purchases.
  • Maintained optimal financial controls by following loss prevention procedures and protecting cash assets.
  • Explained complicated Utility Bills, taking payments, processing refunds, filing fraud and bill disputes, setting customers up on Auto Bill Pay and updating payment methods.
08/2012 to 03/2016 Customer Retention Specialist DIRECTV | City, STATE,
  • Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
  • Communicated with vendors regarding back order availability, future inventory and special orders.
  • Effective liaison between customers and internal departments.
  • Quickly and accurately answered customer questions, suggested effective solutions and resolved issues to increase customer satisfaction
  • Handled high-volume paperwork and collaborated with various department to resolve invoicing and shipping problems.
  • Recommended, selected and helped locate and obtain out-of-stock product based on customer requests.
  • Achieved and consistently exceeded revenue quota through product and service promotion during routine calls.
  • Cross-trained and provided back up for customer service managers.
  • Handled over 60-90 calls per shift signing up new customers, retrieving customer data, presenting relevant product information and cancelling services.
  • Bolstered customer retention by creating and offering unique discount options and inspiring interest in new product lines.
  • Used consultative sales approach to understand customer needs and recommend relevant offerings.
  • Managed timely and effective replacement of damaged or missing products.
  • Assisted customers by listening closely, finding solutions to problems and making recommendations based on extensive product knowledge.
  • Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
Education
Expected in High School Diploma | John Marshall Community High School, Indianapolis, IN GPA:
Expected in 08/1994 Associate of Arts | Computer Applications Interactive College Of Technology, Atlanta, GA GPA:
Expected in 07/1989 Associate of Arts | Small Business Administration And Management IUPUI, Indianapolis, IN, GPA:

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Resume Overview

School Attended

  • John Marshall Community High School
  • Interactive College Of Technology
  • IUPUI

Job Titles Held:

  • Medicare AB Claims/ DME Claims Customer ServiceRep
  • Charge Point Driver Support Rep
  • Small Business Sales and Customer Service Rep
  • Customer Retention Specialist

Degrees

  • High School Diploma
  • Associate of Arts
  • Associate of Arts

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