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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

Skilled Customer Service Agent committed to addressing customer concerns with speed, accuracy and professionalism. Customer Service Representative who maintains a high level of professionalism, patience and efficiency to minimize customer dissatisfaction and increase customer loyalty. Call Center Representative versed in customer support in high call volume environments. Superior computer skills and telephone etiquette.

Highlights
  • Call center management experience
  • Employee relations specialist
  • Conflict resolution proficiency
  • Proficient with Microsoft Office Suite
  • Service solutions expert
  • Strong problem solving ability
Accomplishments
Documentation
  • Wrote and edited documents to keep staff informed on policies and procedures.
Experience
Weekend Team Lead, 10/2013 to 02/2014
Cssi, Inc.Gaithersburg, MD,
  • Managed agents for the American Specialty Health campaign. Ensured my team was following the proper call procedures, call floor policies, and quality assurance goals and the importance of a successful call record.
  • Take escalated calls from the call floor, provide resolution within realm control, or send up the issue and callback customer with researched resolution.
  • Consulted and trained on changes provided by our client quickly and efficiently to maintain compliancy and team morale.
  • Guided peer mediations with agents to resolve conflicts and misunderstandings to keep our fun work environment. Prepared corrective actions for agents as needed regarding work performance/attendance and follow-up with agents to avoid termination if necessary.
  • Monitored daily reports such as Workforce Management, approve time sheets, and other related duties.
Subject Matter Expert, 09/2013 to 02/2014
Southern New Hampshire Medical CenterMerrimack, NH,
  • Improved and streamlined new hires functionality of the ASHCore system, ASH Module program, and the use of online materials to facilitate a variety of calls.
  • Assisted our quality assurance department by doing preliminary coaching sessions to increase proper handling of members. Advised representatives on phone etiquette, pronunciation, and role play scenarios.
  • Re-educate on the required documentation needed to be placed in the member record, re-train in areas the agent may be struggling, so agent can successfully obtain a quality score of 95%.
  • Within this role I established myself as the liaison between management and representatives to keep an open line of communication.
Health Advisor Specialist, 09/2012 to 09/2013
NOVO 1City, STATE,
  • Researched beneficiary required HIPAA information to verify eligibility to participate in the fitness programs offered by American Specialty Health.
  • Ascertain the nature of the call and record information in the Communication Log, look up member information using information in CHIP, AshCore and/or E-Claims and XenDocs and provide information to caller, Forward logs regarding questionable member eligibility to Research Unit for verification of coverage/benefits, Utilize appropriate resources, including those online; to provide timely responses.
  • Enroll beneficiaries into a fitness club or home fitness, send requests to have member’s gym changed if the person has been attending a new facility without informing ASH and paper enrollments if unable to enroll member via computer, and aid in locating health clubs near beneficiary zip code.
  • Accept payments from members who have an annual fee. Send out of network reimburse claim forms for eligible participants while informing them of required documentation and specific time frames, so the claims department can process the submission within timeframe.
Patient Services Representative, 04/2010 to 07/2010
MedsynergiesCity, STATE,
  • Answered multiple Medical center/physician lines using HIPAA guidelines regarding patient inquiries such as procedure performed & diagnosis, outstanding balances & collective action, and retrieved insurance information.
  • Advised patients to contact insurance carrier if patient responsibility was not correct on billing statement per insured's EOB or there was no payment from health coverage provider. Also, issue temporary holds on accounts when insurance needs to be reviewed or correct an error on their side.
  • Refreshed patient accounts to reflect bankruptcy, added legal representation, and processed requests for itemized bill summary.
Education
High School Diploma: Recommended High School Diploma, Expected in
Macarthur High School - Irving, TX
GPA:
: Health Information Specialist, Expected in
CCI Training Center - Arlington, TX
GPA:
Skills
HIPAA, Microsoft Excel, Microsoft Office, Microsoft Powerpoint, Microsoft Word, Ms Office, Powerpoint, Proactive, Problem-solving, Self Motivated, Team Player, Trouble-shooting,  Subject Matter Expert, Team Lead, Customer Service, Customer Service Rep Medicare,
  • Knowledgeable of HIPAA, PHI, and Medicare
  • Microsoft Office and Outlook experience
  • Proactive, Self Motivated, Team Player
  • Accountable, Adaptable, Career-minded

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Resume Overview

School Attended

  • Macarthur High School
  • CCI Training Center

Job Titles Held:

  • Weekend Team Lead
  • Subject Matter Expert
  • Health Advisor Specialist
  • Patient Services Representative

Degrees

  • High School Diploma

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