Customer Service Representative
Resume:
JENNIFER
WARE
*************@*****.***
South Bend, IN 46617
Bold Profile
Proven Claims Analyst with a track record of enhancing client satisfaction and reducing errors in eligibility determinations at Sagility Healthcare/Cambia. Excelled in claims analysis and interpersonal communication, demonstrating critical thinking and policy interpretation skills. Achieved top performance metrics, underscoring a commitment to excellence and regulatory compliance. PROFESSIONAL SUMMARY
Sagility Healthcare/Cambia - Claims Analyst
South Bend, IN • 01/2024 - 09/2024
Sagility Healthcare/Compass Group - Customer Service Representative
South Bend, IN • 09/2021 - 12/2023
WORK HISTORY
Maintained strict confidentiality with all personal data as per company guidelines.
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Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
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Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
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Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
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Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
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Examined claims forms and other records to determine insurance coverage.
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Researched claims and incident information to deliver solutions and resolve problems.
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Documented information gathered in field and uploaded data to company database for efficient processing using Faucets.
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Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
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Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
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Verified accuracy of Faucets records to maintain accuracy of records database.
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• Ordered Medical information to complete Faucets files. Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
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Responded to customer requests for products, services, and company information.
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SKILLS
• Claims
• Claims analysis
Interpersonal and written
communication
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• Policy Interpretation
• Proficient in Software
• Document workflow
• Data Interpretation
• Claim investigation
• Skilled in Citrix and Faucets
• Claims review
• Claims Processing
• Critical Thinking
• Computer Skills
• Records Review
• Denied claims identification
• Coverage Determination
• Benefits review
• Database Management
• Claims Evaluation
• Report and Records Review
• Claims Investigation
• Policy analysis
• Regulatory Compliance
Davenport College
Kalamazoo, MI • 07/1999
Associate Of Applied Science:
Executive Administrative Assistant
EDUCATION
Xerox, ACS - Eligibility Specialist
South Bend, IN • 03/2010 - 06/2015
Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
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Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
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Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
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Developed strong product knowledge to provide informed recommendations based on individual customer needs.
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Processed customer service orders promptly to increase customer satisfaction.
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Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
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Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
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Assisted customers in navigating company website and placing online orders, improving overall user experience.
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Utilized customer service software to manage interactions and track customer satisfaction.
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Exceeded performance metrics consistently, earning recognition as a top performer within the team.
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Tracked customer service cases and updated service software with customer information.
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Developed customer service policies and procedures to meet and exceed industry service standards.
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Fostered a customer-centric culture within the team by consistently reinforcing the importance of empathy, understanding, and patience in all interactions with clients.
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Streamlined call center processes for improved efficiency and reduced wait times.
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Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
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Exhibited high energy and professionalism when dealing with clients and staff.
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• Investigated and resolved customer inquiries and complaints quickly. Responded to customer requests, offering excellent support and tailored recommendations to address needs.
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• Maintained up-to-date knowledge of product and service changes. Met customer call guidelines for service levels, handle time and productivity.
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Followed up with customers about resolved issues to maintain high standards of customer service.
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Educated customers about billing, payment processing and support policies and procedures.
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Reduced errors in eligibility determinations by maintaining thorough knowledge of program guidelines and regulations.
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Enhanced client satisfaction by providing timely and accurate eligibility determination for various assistance programs.
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Provided exceptional customer service through prompt response times, clear communication channels, and diligent follow-up practices.
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Ensured compliance with local, state, and federal regulations during all phases of the eligibility determination process.
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Maintained detailed records of client interactions, ensuring accuracy and confidentiality of sensitive information.
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Assisted clients with accurate eligibility form, application and document completion.
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Interviewed applicants and explained scope of different available benefits.
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Streamlined application process for clients by implementing efficient case management techniques, improving overall service.
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Scheduled appointments with applicants to gather information and explain benefits processes.
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Communicated with people from various cultures and backgrounds on application process.
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Developed strong rapport with clients by effectively communicating complex program requirements and processes.
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Established trust with clients by consistently demonstrating empathy, professionalism, and a commitment to their wellbeing.
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Reviewed applications for different aid programs and determined which qualification criteria for individuals.
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Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
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Coordinated referral services for eligible families, connecting them with vital support systems and resources.
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