Claims & Customer Service Professional
Resume:
DAMESHA JOHNSON
San Antonio, TX 210-***-**** ****************@*****.***
PROFESSIONAL SUMMARY
Experienced Claims and Customer Service Professional with 10+ years of success in healthcare, insurance, claims processing, technical support, and customer relations. Skilled in claims investigation, benefits verification, prior authorizations, HIPAA compliance, and resolving complex customer concerns. Proven ability to manage high-volume workloads while maintaining accuracy, productivity, and exceptional service standards. Recognized for strong communication skills, attention to detail, and commitment to delivering positive customer experiences.
CORE COMPETENCIES
Claims Processing & Investigation; Medical Claims Review; Insurance Verification; Prior Authorization Management; HIPAA Compliance; Benefit Eligibility Verification; Customer Service Excellence; Call Center Operations; Technical Support; Medical Billing Software; Data Entry & Documentation; Conflict Resolution; Problem Solving; Complaint Resolution; Cross-Functional Collaboration; Time Management
PROFESSIONAL EXPERIENCE
Medical Claims Representative II CVS Health (Remote) November 2025 – March 2026
• Reviewed and processed medical claims while ensuring HIPAA compliance and accuracy.
• Investigated and resolved complex claims, denials, and payment issues.
• Verified member eligibility, provider information, and benefits.
• Documented claim actions and maintained accurate records.
• Collaborated with providers and internal teams to resolve claim issues.
• Met quality and productivity goals in a high-volume environment. Claims Representative GlowTouch / UnifyCX (Remote) July 2023 – April 2025
● Process high volumes of insurance claims in a fast-paced remote environment while maintaining accuracy and compliance.
● Review claim submissions and assist policyholders with required documentation to reduce processing delays and errors.
● Ensure accurate claim documentation and record maintenance in accordance with company policies and industry regulations.
● Manage large caseloads while consistently meeting deadlines for claims review, benefit verification, and authorization requirements.
● Provide exceptional customer support by resolving inquiries and explaining claim procedures clearly and professionally.
Healthcare Customer Service Representative Maximus (Remote) December 2020 – February 2023
● Processed medical claims accurately while adhering to strict production and quality standards.
● Maintained HIPAA compliance when handling confidential patient information and healthcare records.
● Verified insurance benefits, eligibility, and authorization requirements for healthcare services.
● Maintained accurate patient records through detailed documentation and data entry.
● Collaborated with healthcare providers, patients, and insurance representatives to resolve claim and coverage issues.
Customer Service Chat Representative TaskUs (Remote Contract) November 2018 – December 2020
● Delivered customer support through chat channels, resolving technical and account-related concerns.
● Guided customers through troubleshooting steps for software and hardware issues.
● Maintained detailed records of customer interactions and resolutions.
● Identified recurring customer issues and escalated trends to management for process improvement.
Customer Service Specialist AT&T September 2014 – November 2018
● Assisted customers with billing, account management, service plans, and technical support inquiries.
● Maintained an average workload of approximately 95 customer interactions daily while meeting performance goals.
● Improved first-call resolution rates through active listening and effective problem-solving techniques.
● Educated customers on available products and services, contributing to increased sales and customer retention.
EDUCATION
High School Diploma
Roosevelt High School
May 2006
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