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Senior Claims Processing Specialist Resume Example

Resume Score: 100%

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SENIOR CLAIMS PROCESSING SPECIALIST
Professional Summary
To obtain a position that will enable me to use my strong organizational skills, educational background and ability to work well with people To exemplify leadership responsibilities of problem-solving and planning, while being a team-player and exhibiting excellent customer service skills within a challenging environment to achieve the corporate goals Suggestively sold computer hardware, software, and other items to customers for a better computer experience, in addition to assisting them with their purchases Acted as a Level II Technician to provide technical support to Level I Computer Technical Analysis; when standard repair solutions were not helpful, I approved all advanced technical diagnostic steps and replacement hardware for customers' computers. In addition, I mentored new-hire classes in developing their troubleshooting skills and techniques over the telephone, allowing me sole responsibility for individuals, which were under my supervision as part of the Team Manager Supervision Team ATTRIBUTES Independent and analytical with strong problem-solving skills to develop appropriate plan of action Several years of excellent customer service orientation in fast paced environments Self-motivated with the proven ability to reach goals and meet deadlines Excellent oral and written communication skills Strong organizational, multitasking and methodical abilities Knowledgeable of planning principles and analytical processes within a retail and office environment Effective in time management Team building and leadership oriented Productive and strong technical knowledge of Microsoft Office Four years of experience within a compliance/insurance corporate environment Willingness to learn and adapt to new roles quickly Flexible in working various schedules for shifting work flows and altering assignments Works individually and within a team environment
Experience
June 2010
to
August 2014
Company NameCity, StateSenior Claims Processing Specialist
  • Possessed full ownership of the medical portion of the automobile claim involving injured persons Contacted eligible insured persons regarding injuries in which they have sustained during an accident Developed and evaluated facts to determines eligibility of benefits by use of investigative, analytical, verbal and written communication Gathered all pertinent information and documentation needed from the injured party and additional information which may be necessary for the overall claim Reviewed accident photos to determine if accident is pertinent to injuries being claimed Authorized medical benefits once eligibility has been determined Performed the necessary research for appeals regarding denial of medical benefits or bills and responds to inquiries within the allowed time frame Responded to claim correspondence from customers, regulators, attorneys and ensures proper handling with accuracy within compliance guidelines Monitored and reassessed care plans as needed for injured persons Reviewed processor files for quality and compliance guidelines Reviewed and accurately closed medical claims once benefits have exhausted or they have reached a certain time period by preparing release agreements that summarize the terms and agreement Managed day-to-day operations of data entry, typing, and filing Communicated effectively internally/externally by phone with customers, medical providers and attorneys that have inquiries regarding claims while providing a high level of customer service Maintained call management by ensuring calls are handled expeditiously and with quality within the call center by myself and fellow processing analyst by monitoring the call center call volume Assisted with claims that had Coordinated Benefits Assisted Team Lead with analysis for special projects, reports, and data request for upper management team Assisted team with completion of additional tasks during periods of higher claim volumes throughout the year.
November 2009
to
March 2010
Company NameCity, StateAssistant Store Manager
  • Handled store inquiries independently while performing a variety of duties and supervised employees during my shifts Promoted sales by demonstrating merchandise and products to customers Completed store operational requirements by scheduling and assigning employees appropriately Assisted Store Manager with reports and data requests for the District Manager Supported with basic stock level adjustments Attracted customers by originating display ideas and producing merchandise displays on sales floor Maintained inventory, reconciled cash with sales receipts, prepared operating reports, and managed daily records of transactions Contributed to team effort by accomplishing related results as needed Responsible for the reviewing all merchandise shipped to the store Ordered merchandise and prepared requisitions to replenish merchandise on hand Reviewed current sku markers and add new sku markers to all levels of merchandise to ensure proper transactions and correct inventory Assisted Manager in ensuring compliance of employees with established security, sales and record keeping procedures/practices.
April 2009
to
August 2009
Company NameCity, StateConference Coordinator
  • Communicated directly with small, medium and enterprise level businesses and government agencies in a high volume call center Accepted and established conference call reservations Greeted and directed meeting attendees in the appropriate conference rooms Facilitated conferences for premium customers and managed conference bridges and calls to ensure the highest level of quality Provided professional, timely and accurate deliver of service to all customers at all times.
August 2005
to
November 2007
Company NameCity, StateComputer Technical Support Representative
  • Performed troubleshooting on Dell desktops and laptop computers in a call center environment.
  • Specialized in assisting clients identify hardware and software issues.
  • Diagnosed Internet problems; after diagnostics was complete, instructed clients with permanent repair solutions for all problems involving their computer systems.
  • Assisted clients with the installation of components which they needed or wanted installed on their computer.
Education
8/2013
The University of AlabamaCity, StateBachelor of Science: Consumer Science Consumer AffairsConsumer Science Consumer Affairs
5/2008
East Mississippi Community CollegeCity, StateAssociate of Applied Science: Business and Marketing ManagementBusiness and Marketing Management
Skills
analyst, basic, Benefits, bridges, call center, hardware, conferences, clients, customer service, data entry, Dell desktops, documentation, filing, frame, government, inventory, laptop computers, Team Lead, enterprise, producing, quality, record keeping, research, sales, scheduling, Store Manager, phone, troubleshooting, typing, written communication
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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

School Attended

  • The University of Alabama
  • East Mississippi Community College

Job Titles Held:

  • Senior Claims Processing Specialist
  • Assistant Store Manager
  • Conference Coordinator
  • Computer Technical Support Representative

Degrees

  • Bachelor of Science : Consumer Science Consumer Affairs
    Associate of Applied Science : Business and Marketing Management

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