pua one stop adjudicator resume example with 5+ years of experience
As a seasoned professional for over ten years, Jessicahas expert experience in customer service, sales, building, managing, engaging, coaching, and training teams, to high performance. Ms. Claire brings a background that includes two years of extensive leadership training and development from Cox Communications as a Sales Effectiveness Counselor. Jessicawas part of a team of four responsible for training the first 400+ in-house chat agents to replace third-party vendor representatives over a two-year time span. Ms. Claire has traveled across divisions to various stores to develop best practices and implement the company-wide rollout of new solutions and technology for Kroger. Jessicatakes pride in her ability to proactively identify gaps in process improvement and suggest feedback and/or coaching for immediate improvement. Ms. Claire has led, trained, and developed teams that consistently meet and surpass expectations through effective communication, problem-solving and critical thinking. Jessicahas what it takes to help an organization achieve peak performance, especially as a trainer. More than anything, training and implementing best practices has become a true passion of hers.
Critical Thinking
Task Oriented
Communication skills
Leadership skills
Teamwork skills
Interpersonal skills
Learning/adaptability skills
Self-management skills
Organizational skills
Computer skills
Problem-solving skills
Open-mindedness
Strong work ethic
- https://www.linkedin.com/in/tracy-Claire-511208187
- Claimant acknowledgment and establishment of new claims.
- Adjudicate claims within guidelines ensuring the benefit eligibility is correctly determined.
- Responsible for researching and resolving escalated and complex claim issues promptly.
- Review supporting documentation for accuracy.
- Connect with applicants to guide them through the claim process.
- Practice all policies and procedures to PHI and HIPAA.
- Document all claimant information, communications in the PUA system.
- Ensure privacy, confidentiality, and precision with all work.
- Maintain working knowledge of client's requirements.
- Investigated high volume of insurance claims to determine validity and coverage eligibility.
- Travel to different locations to implement rollout of new technology and processes
- Provided feedback for technology enhancement resulting in 75% increased accuracy in completion of daily tasks.
- Perform functional testing of supported technologies following system and application enhancements, upgrades, and patches to validate system integrity and functionality
- Train and educate all levels of organization on newly improved processes, technology changes to improve business operations
- Create efficient processes and training materials to improve in-stock for stores while reducing labor costs for enterprise
- Report to Kroger leadership on results of sustainment, provide feedback and advice on future training rollouts
- Develop new technology and processes to improve efficiency
- Collaborate with divisions to create training and roll-out plan that fits their schedule
- Train all levels of the organization on new technology and process improvement
- Help assist other Retail Operation teams to help success of their projects by providing honest and constructive feedback
- Present technology and process improvement to all levels of organization
- Enhanced understanding and implementation of Business Units strategic goals. Oversee use of standard process workflows by team
- Set, enforced, and optimized internal policies to maintain responsiveness to demands.
- Devised processes to boost long-term business success and increase profit levels.
- Evaluated interactions between associates and customers to assess personnel performance and implement strategies for customer satisfaction improvement.
- Led process improvement and problem-solving efforts to create standard procedures and escalation policy for customer support team.
- Handled complaints, provided appropriate solutions and alternatives within appropriate timeframes, and followed up to achieve resolution.
- Performed duties and provided service in accordance with established operating procedures and company policies.
- Established performance and service goals and held associates accountable for individual performance.
- Conducted training and mentored team members to promote productivity, accuracy and commitment to friendly service increasing NPS scores by 27%.
- Applied best practices in customer service, sales and employee management to exceed organizational goals.
- Developed and delivered engaging sales presentations to convey product benefits.
- Conducted orientation sessions to assess skill levels and areas of strength and weakness.
- Led learners through appropriate activities, discussions, and debriefs
- Facilitate learning to develop participants' skill sets. This includes classroom instruction, team meetings, and online Learning debriefs
- Provide feedback to learners to aid with knowledge transfer and behavior change
- Pursue development opportunities focused on facilitation, learner engagement, and classroom management excellence
- Managed classroom and participants during training by tracking attendance, addressing inappropriate behavior, and documenting performance, both strengths and development needs. Perform all administrative duties including class and lab preparation, schedule administration, and participant record maintenance (e.g., test scores, evaluations, and attendance)
- Perform all LMS prerequisite requirements and post-training duties including evaluation
- Perform other duties as requested
- Collaborate with peers to establish best practices
- Guided up to 20 Sale and Retention Agents to consistent attainment of goals per month.
- Achieved performance improvement by identifying individual skill-building needs based on analysis of statistics, monitoring call quality, observation of agent interactions, and 1:1’s
- Frequently tapped to address challenges while concurrently providing training for new hires and established agents, evaluating agent performance, handling escalations, and optimizing agent performance.
- Facilitated new hire onboarding and nesting programs for Inbound Sales and Retention team
- Reduced ramp-up time by replacing unproductive activities with training modules dedicated to calling center system operation and troubleshooting errors.
- Supervised team of up to 29 staff members.
- Collaborated with team of 12 in the development and implementation of new technology and processes.
- Resolved product issue through consumer testing.
- Achieved 90% increase of New Hire Scorecard by introducing "How to Read ICOMS Errors" to NH Training.
- Tasked with delivering new product training for line customer service agents; reduced class time by 25%.
- Diplomatically addressed the subpar performance of colleagues on the training team by engaging in open communication that established trust and created a highly productive work environment.
- Continually maintained 100% rating on L1 Weekly Surveys
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Resume Overview
School Attended
- Community College of Southern Nevada
- Palo Verde High School
Job Titles Held:
- PUA One-Stop Adjudicator
- Business Specialist - Trainer
- Customer Care Supervisor
- Sales Effectiveness Counselor
Degrees
- High School Diploma
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