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Jessica Claire
Montgomery Street, San Francisco, CA 94105
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Skills
  • Research and data analysis
  • Understands insurance benefits
  • Resourceful and reliable worker
  •  Excellent problem solver
  • Office support
  • Excellent verbal communication
  • Energetic
  • Efficient
  • Reliable
  • Honest
  • Friendly

 

Work History
02/2011 to 2017
Provider Network Specialist Centene Corporation Concord, NC,
  • Responsible for researching and resolving escalated provider concerns related to claims and contract payments.
  • Worked closely with other departments, i.e. claims, customer relations benefits, medical management and membership accounting to identify and correct issues causing errors and inefficiencies.
  • Served as a Liaison between Customer Relations and Network Development. Trained Customer Service Staff to handle provider calls and created a Provider FAQ document.
  • Administrator for secure provider website, Carelink. Provisioned and trained new users, maintained database of active accounts, acted as Account Manager for affiliated community providers. Worked to implement enhancements to the site. Conducted onsite training and composed articles educating providers about the website 3x per year.
  • Assisted in managing the incoming claims pool, ensuring that vendors and providers are correctly loaded into the Epic claims platform. This reduced the volume of unidentified claims from a peak of over 3000 to a manageable daily number.
  • Conducted and compiled results for semi-annual Behavioral Health surveys.
  • Compiled Outpatient Therapy Directories.
03/2004 to 02/2011
Provider Network Coordinator Delta Dental Plan Of Arkansas Sherwood, AR,
  • Worked as a phone representative handling a high volume of provider calls on a daily basis.
  • Diligently used patience and tact to resolve their concerns.
  • Researched and responded to provider issues forwarded to network development for resolution.
2000 to 02/2004
Customer Relations Representative Accentcare Athens, GA,
  • Worked as a phone representative handling a high volume of customer concerns and complaints.
  • Assisted members to understand their medical plan, benefits and to choose medical providers and locations available to them.
  • Assisted members with claims and premium billing issues.
02/1994 to 11/1999
Membership Accounting Representative Kaiser Permanente City, STATE,
  • Maintained monthly premium billing accounts for 1000 employer groups in a high level production environment.
  • processed member enrollments, terminations and status changes accurately and efficiently to keep the accounts clean.
Education
Expected in 2013
Bachelor of Arts: Business Administration
San Francisco State University - San Francisco, CA
GPA:

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Resume Overview

School Attended

    Job Titles Held:

    • Provider Network Specialist
    • Provider Network Coordinator
    • Customer Relations Representative
    • Membership Accounting Representative

    Degrees

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