Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
Professional Summary
Energetic team player with progressively responsible experience offering administrative experience in both corporate and non-profit office environments. Organized and professional. Expertise includes verifying insurance coverage and processing Inpatient and outpatient admissions.
Skill Highlights
  • Professional and Mature
  • Strong Problem Solver
  • Advanced MS Office Knowledge
  • Dedicated Team Player
  • Strong Interpersonal Skills
  • Proofreading
  • Insurance Eligibility/Verifications
  • Knowledge of MCOs, Medicare and Arizona AHCCCS
  • Medical Management Software
  • Strong Work Ethic
Professional Experience
Prior Authorization Referral Specialist/Admissions, 07/2010 to Present
Christus HealthHawkins, TX,
  • Ensured timely and accurate processing of inpatient and observation hospital emergency room admissions.
  • Processed authorization requests for pre-scheduled inpatient hospital admissions ordered by requesting physician.
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Efficiently performed insurance verification and pre-authorization functions.
  • Developed effective relationships with all other departments through clear communication.
  • Provided accurate and appropriate information in response to provider authorization inquiries.
  • Served as support for field concurrent review nurses.
Member Services Representative, 04/2008 to 07/2010
, ,
  • Contacted contracted physicians to ensure they were in compliance with their contract for supplying current and future health plan members with timely appointments.
  • Served as first point of contact for incoming calls to Health Plan, answering inquiries from members and providers related to AHCCCS and Medicare programs.
  • Directed calls other departments when appropriate.
  • Exceeded department benchmarks related to call volume, answer speed, and abandonment rate.
  • Verified member insurance eligibility and enrollment using the AHCCCS website.
  • Participated in the development and enhancement of department policies and procedures, work processes, and training materials.
  • Contact providers on behalf of Advantage/AHCCCS members receiving bills/statements to assist in coordinating correct insurance billing information.
  • Assist members that have paid for services and are entitled to reimbursements, by contacting the provider and providing correct billing information for date of service.
  • Created weekly call logs for each Member Service Representative as a tool for tracking calls received for use in monthly state reports to AHCCCS.
  • Create and distribute monthly employee newsletter.
Office Administrator, 11/2005 to 04/2008
Partners Healthcare SystemCity, STATE,
  • Served as Office Administrator and first point of contact for large Presbyterian Church.
  • Assisted Senior Pastor, Associate Pastor, Youth Minister and Minister of Visitation with various daily tasks and projects.
  • Served as point of contact for all outside visitors needing to gain access to the building.
  • Answered incoming calls and directed callers to appropriate staff member.
  • Created and printed weekly church newsletter and bulletins Monitored weekly volunteers who assisted with preparing the newsletter for mailing.
  • Maintained records of debits and credits to Postal Permit account ensuring sufficient monies were available for weekly mailings.
  • Prepared incoming bills for payment by coding with proper GL account.
  • Maintained church database using Church Helpmate software.
  • Prepared weekly slides for Sunday music selections.
Publications Editor/Administrative Assistant, 07/2003 to 11/2005
  • Created and printed weekly devotional book and bulletin and monthly newsletter for largest Tucson area Presbyterian Church.
  • Created and implemented new bulletin format resulting in overall paper reduction.
  • Served as Administrative Assistant for 2 Associate Pastors and answered call in their absences.
  • Produced and mailed a variety of postcards and letters to Mid High and Senior High students.
  • Created spreadsheet for all current Mid High, Senior High and College group events.
  • Responsible for accurately accounting for all money received for each event.
Education and Training
: , Expected in
Oregon School for the Deaf - Salem, OR
Beginning ASL I, II & III
: Computerized Information Processing, Expected in
Trend Business College - Salem, OR
Computerized Information Processing
Business Accounting Word Processing: , Expected in
Chemeketa Community College - Salem, OR
Accounting, Administrative Assistant, billing, book, Strong Interpersonal Skills, database, GL, Insurance, letters, mailing, Medical Management, access, money, MS Office, Office, newsletter, policies, Problem Solver, processes, coding, Proofreading, receiving, spreadsheet, Team Player, training materials, website, Word Processing

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School Attended

  • Oregon School for the Deaf
  • Trend Business College
  • Chemeketa Community College

Job Titles Held:

  • Prior Authorization Referral Specialist/Admissions
  • Member Services Representative
  • Office Administrator
  • Publications Editor/Administrative Assistant


  • Business Accounting Word Processing

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