Data Entry Customer Service

Crystal N. Jordan

Moncks Corner, SC *****

443-***-**** (cell)

E-mail: *******.*********@*******.***

OBJECTIVE: To be associated with an establishment which will allow me to utilize my skills and license to gain further experience, knowledge, and opportunities for advancement within the company. I’m seeking to grow with a company that is also growing in the workforce by taking in knowledge and applying my skills that will help me and the company better reach our goals for success.

EXPERIENCE:

Kaiser Permanente

Resolution Manager 7/22-8/23

I played a crucial role in providing exceptional customer service and resolving complex issues for members and healthcare providers. My primary responsibility was to investigate and address concerns, complaints, and disputes related to healthcare services, insurance claims, billing, and other administrative matters. I effectively analyzed situations, facilitated communication, and found satisfactory resolutions that will enhance member satisfaction while ensuring quality healthcare experiences. Assisted with high priority queues such as the Mental Health queue as well as the Department of Managed Health Care queue insuring that member’s grievances we resolved in a timely manner.

Administrative Strategies

Independent Claims Adjuster 6/22-4/23

I was Responsible for investigating and processing travel insurance claims. Evaluate claim validity, determined coverage, and ensured fair settlements. Conducted thorough investigations, analyzed policy terms, and gathered supporting documents. Communicated with claimants, agents, and service providers. Maintained detailed records and adhered to industry regulations. Demonstrated strong analytical, communication, and customer service skills.

Kaiser Permanente

Project Manager 8/17-7/22

Successfully completed a $1 million healthcare IT implementation project, resulting in improved efficiency and reduced operational costs by 15%. Implemented standardized project management methodologies, resulting in a 20% increase in project success rate.

Led the successful launch of a new telemedicine program, reaching 10,000+ patients within the first six months.

Assisted with managing project budgets, tracking expenses, and ensuring cost-effective resource allocation.

Billing/Claims Specialist & Data Entry 7/14-8/17

I assist members with billing issues and concerns, take payments, adjust and provide plan benefit information. I assist Providers with the status of claims and submit claims to be reprocessed that haven’t paid correctly or have denied incorrectly. Assisted with payments, billing adjustments and financial assistance application status. Entered data from billing audits into Microsoft Excel Spreadsheets.

Managed Staffing/Aetna

Intake Claims Specialist 12/13-3/14

I was responsible for efficiently and accurately processing healthcare claims. I was involved in reviewing incoming claim documentation, verifying policy information, and initiating the claims adjudication process. I paid close attention to detail, displayed strong organizational skills, and ensured accurate reimbursement for healthcare services provided.

Puerto Rican Chamber of Commerce

Recruiter/Marketing/Sales 4/10-11/13

Assisted the team in attracting and engaging businesses and organizations to join the chamber. Promoted the benefits and value of chamber membership, built relationships with prospective members, and facilitated the enrollment process. Effectively communicated the chamber's mission, understood the needs of businesses, and established strong connections that contributed to the growth and success of the chamber and its members.

Cross Country Home Services

Claims Specialist 3/07-11/09

Reviewed and evaluated home warranty claims submitted by customers. Verified coverage eligibility based on the terms and conditions of the home warranty contract. Coordinated with contractors and service providers to schedule repairs or replacements as necessary. Communicated with customers, contractors, and service providers to provide updates on claim status and resolve any issues or concerns. Maintained accurate and detailed documentation of claim activities, including claim reviews, approvals, denials, and payments. Collaborated with other internal teams, such as customer service and sales, to ensure smooth claim processing and customer satisfaction. Adhered to company policies, procedures, and industry regulations while handling claims. Monitored claim trends and identify opportunities for process improvements or enhanced customer experiences. Met and exceeded established performance metrics, such as claim processing time, customer satisfaction ratings, and claim resolution rates.

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