Remote Customer Service Specialist with Healthcare Focus

JACQUELYN CAUDILL

Viper, KY • 606-***-**** • *********.*********@*****.***

PROFESSIONAL SUMMARY

Detail-oriented Customer Service Representative with 6+ years of remote experience in healthcare insurance, medical claims processing, short-term disability, and high-volume call center operations. Skilled in de-escalation, coverage explanation, multi-system navigation, medical terminology, and HIPAA compliance. Experienced in handling 50–75 inbound calls daily while maintaining accuracy, professionalism, and empathy. CORE COMPETENCIES

• Healthcare Customer Support • Insurance & Medical Claims • Prior Authorization • COB

• HIPAA Compliance • Claim Denials • Multi-System Navigation • High-Volume Call Handling

• De-Escalation • Documentation • Microsoft Office • Google Workspace • Adobe • Zoom PROFESSIONAL EXPERIENCE

Ascension – Troy, MI

Customer Service Representative May 2023 – Present

• Assist members, providers, and insurance agencies with claims, coverage, benefits, and billing.

• Explain network status, provider tiers, out-of-pocket costs, and patient responsibility.

• Review and interpret claim denials; guide members through next steps or appeals.

• Handle prior authorization, medical necessity, and coordination with nurses and providers.

• Manage Coordination of Benefits (COB) and verify primary vs. secondary insurance.

• Navigate multiple internal systems; manage 50–75 calls per day with accuracy. Sedgwick – Indianapolis, IN

Customer Service Representative May 2021 – Jan 2023

• Process short-term disability and insurance claims; initiate new claims for employees.

• Navigate multiple platforms to verify eligibility and documentation.

• De-escalate callers and maintain professional communication. Sedgwick – Memphis, TN

Customer Service Representative Nov 2020 – May 2021

• Assisted with claim intake, benefit explanations, documentation, and updates.

• Ensured accuracy and compliance with privacy requirements. SYKES

Tier 2 Customer Service Representative Nov 2019 – Oct 2020

• Supported front-line representatives with claim issues and call guidance.

• Reviewed calls for quality and helped de-escalate complex situations. Letcher Funeral Home – Whitesburg, KY

Desk Clerk May 2017 – Oct 2017

• Managed multi-line phone system, scheduling, payments, and reception operations. Southeast Community College – KY

Maintenance Jun 2016 – May 2017

• Performed general building maintenance, cleaning, and groundskeeping. Jenkins Hospital – Jenkins, KY

Desk Clerk Sep 2006 – Apr 2008

• Scheduled appointments, handled medical records, completed insurance forms, and assisted with billing.

EDUCATION

Sullivan University – Medical Coding & Billing (2023–2024) Bryan University – Pharmacy Technician Certificate (In Progress) Southeast Community College – Associate Degree in Criminal Justice (2018) CERTIFICATIONS

• CPR Certified • Certified Nurse Aide (CNA) • NOTIC

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