provider relations representative resume example with 9+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • :
Professional Summary

To seek and maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

  • Achieved management by completing tasks, and helping team with accuracy and efficiency.
  • Tau Sigma
    • Database Search and Data Entry Skills
    • Providing Information and Resources
    • Explaining Policy and Procedures
    • Quality Standards and Protocols
    • Verbal and Written Communication
    • Administrative and Office Support
    • Resolving Problems
    • Organized and Efficient
    • Calm and Effective Under Pressure
    • Microsoft Office
    • Documenting and Recording Information
    • Complaint Investigation
    • Registration and Scheduling
Work History
Member Customer Care, 08/2021 to Current
Common SpiritAnkeny, IA,
  • Educated customers on use of banking website and mobile apps.
  • Answered customer inquiries regarding account balances, transaction history, services charges and interest rates.
  • Recognized needs and referred to appropriate representative or line of business for cross-sell or service opportunities.
  • Learned about customer's financial needs, established trust and optimized sales opportunities resulting in quality customer service.
  • Identified sales opportunities and referred customers to branch partners in financial services.
  • Assisted customers with setting up or closing accounts, completing loan applications and signing up for new services.
  • Completed highly accurate, high-volume money counts via both manual and machine-driven approaches.
  • Answered telephone inquiries on checking and savings accounts, loans and lines of credit.
  • Processed customer transactions promptly, minimizing wait times.
  • Established rapport with new clients to increase satisfaction and loyalty.
  • Conducted regular proof work and followed up on chargebacks and deposit corrections.
  • Received loan and utility payments, sending funds to correct destinations.
  • Executed wire transfers, stop payments and account transfers.
  • Wrote and distributed customer correspondence.
  • Calculated fees due, interest and change for customer transactions.
  • Maintained friendly and professional customer interactions.
  • Handled various accounting transactions.
  • Exceeded goals through effective task prioritization and great work ethic.
Provider Relations Representative, 05/2019 to 05/2021
ComcastOdenton, MD,
  • Managed provider relations mailbox by triaging inquiries, facilitating resolution of incoming requests and forwarding requests to appropriate parties.
  • Answered provider inquiries via email, telephone and written correspondence.
  • Formulated focused and individualized resolutions aimed to peacefully settle disputes.
  • Processed and recorded new policies and claims.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Coordinated with contracting department to resolve payer issues.
  • Calculated adjustments, premiums, and refunds.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Modified, updated and processed existing policies.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Verified client information by analyzing existing evidence on file.
  • Acted as claims subject matter expert, answering internal and external questions and inquiries.
  • Generated, posted and attached information to claim files.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Checked documentation for accuracy and validity on updated systems.
  • Reviewed over 100 patient cases per week and verified insurance coverage information.
Lead Retail Sales Consultant, 12/2014 to 05/2019
Winnetka Public SchoolsWinnetka, IL,
  • Submitted reports to senior management to aid in business decision-making and planning.
  • Coached sales associates in product specifications, sales incentives and selling techniques, significantly increasing customer satisfaction ratings.
  • Assisted in driving sales through targeted product presentation and merchandising.
  • Mentored and trained over 10 sales associates for two store locations.
  • Drafted shipment documentation and maintained accurate files.
  • Kept orderly and accurate accounting records by monitoring sales documentation.
  • Offered hands-on assistance to customers, assessing needs and maintaining current knowledge of consumer preferences.
  • Multiplied earnings through sales goal achievement, customer service improvements and commitment to team objectives.
  • Planned and prepared work schedules to assign 16 member team to specific tasks.
  • Recruited, hired and trained 10 associates to develop into productive team members with excellent product knowledge.
  • Facilitated high volumes of cash, credit and gift card transactions, verifying cash drawer balance at end of each shift.
  • Assessed sales reports to identify and enhance sales performance, support inventory oversight and capitalize on emerging trends.
  • Analyzed data and profit and loss statements to compose store budget.
  • Conducted ongoing staff development to help employees achieve growth within job roles.
  • Trained team members in successful strategies to meet operational and sales targets.
  • Exceeded targets by building, directing and motivating high-performing sales team.
  • Oversaw employee performance, corrected problems and increased efficiency to maintain productivity targets.
  • Answered product questions with up-to-date knowledge of sales and store promotions.
  • Coached employees and trained on methods for handling various aspects of sales, complicated issues and difficult customers.
  • Exceeded sales goals and accomplished business objectives by inspiring staff and promoting target products.
  • Mentored sales team in applying effective sales techniques and delivering top-notch customer service.
  • Recruited, interviewed and hired talented individuals bringing dynamic sales expertise to organization.
  • Managed day-to-day staffing and handled scheduling for all store employees.
  • Greeted all customers cheerfully and asked open-ended questions to ascertain needs.
  • Established and optimized schedules to keep coverage and service in line with forecasted demands.
  • Tightened security around store to reduce shrink and alleviate theft.
  • Maintained company's visual merchandise standards through general housekeeping and planograms.
  • Reviewed and resolved differences between accounting information and cash drawer.
  • Opened and closed store
  • Carry keys and alarm codes
  • Access to combination, drop, and time delay safe.
  • Accurately create customers account
  • Manage paperwork and tend to other office tasks
  • Perform product demos and explain product features to customers
Associate/ Cashier, 04/2012 to 05/2014
WalmartCity, STATE,
  • Helped customers complete purchases, locate items and join reward programs.
  • Answered questions about store policies and addressed customer concerns.
  • Restocked and organized merchandise in front lanes.
  • Delivered backup coverage to provide customers with optimal support.
  • Mentored new team members on POS system operation, and customer service strategies.
  • Reviewed weekly sales ads and monitored price changes.
  • Worked closely with shift manager to solve problems and handle customer concerns.
  • Assisted customers by answering questions and fulfilling requests.
  • Worked flexible schedule and extra shifts to meet business needs.
  • Operated cash register for cash, check and credit card transactions with excellent accuracy levels.
  • Collected and authorized payments of guests.
  • Checked identification for proof-of-age for alcohol and tobacco sales.
  • Replenished sales floor merchandise and organized shelves, racks and bins for optimal appearance.
  • Completed inventory counts and ordered merchandise.
Math Facilitator, 06/2010 to 08/2010
After School Matters Inc.City, STATE,
  • Facilitated dialogue between participants, family and program workers to provide best possible program and individualized program.
  • Brought in projects on-time and under-budget by effectively handling routine and complex issues.
  • Collected data on program efficacy through data analysis and implemented solutions for improvement.
  • Identified areas in need of improvement and implemented solutions.
  • Developed and implemented organizational systems to better manage training documentation and progress reporting.
  • Used diverse teaching materials and motivational approaches to reduce learning gaps and instruct students.
  • Monitored field trips and special events to maintain safety and increase attendee retention.
  • Planned and facilitated Math workshops in accordance with mathematics curricula, employing varied methods to maximize attendance.
Bachelor of Arts: Criminal Justice, Expected in 05/2017 to Governors State University - University Park, IL,
Associate of Science: Computer Forensics, Expected in 05/2013 to Kishwaukee College - Malta, IL

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Governors State University
  • Kishwaukee College

Job Titles Held:

  • Member Customer Care
  • Provider Relations Representative
  • Lead Retail Sales Consultant
  • Associate/ Cashier
  • Math Facilitator


  • Bachelor of Arts
  • Associate of Science

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: