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Summary

Goal-oriented customer service professional dedicated to high levels of client satisfaction, excelling at prioritizing, multitasking, and strategic thinking.

Professional Experience
Service Representative|LPL Financial - San Diego, CA|01/2018 - Current
  • Communicates directly with AXA Financial Advisors and clients via phone/email to ensure complex situations, and processing is executed within service level agreements. 
  • Corresponds with internal departments to ensure operational tasks are completed. 
  • Adheres to compliance/risk procedures and exhibits detailed attention to policies while maintaining focus on investors' best interests. 
  • Peer coach for all new hire classes (10 employees) for 4-6 weeks per class. 
  • Responsible for scheduling new hires, providing feedback to management, and evaluating daily and weekly performances. 
  • Cross-trained across all skill sets resulting in working with AXA's top producers within the first year. 
  • One of three representative selected for a dedicated team to manage critical incidents. 
Front Desk Representative|Sweat - Dallas, Texas|07/2015 - 07/2017
  • Delivered an exceptional level of service to clients through adopting feedback, resulting in client retention and increased memberships. 
  • Promoted services, programs, and classes to members and guests.
  • Delegated incoming calls to appropriate staff members. 
  • Trained new employees.


Agency Resource Technician|State Farm - Irving, Texas|05/2013 - 05/2015
  • Delivered customer support to an average of 30 agents a day via phone and email.
  • Corresponded with management team to determine solutions to problems and ensure changes were made to improve agent satisfaction.
  • Resolved policy issues and shared benefits of new technology.
  • Cross-trained and provided back-up for other customer service representatives which reduced call volume by 20 percent. 
  • Consistently exceeded service team goals. 


Auto Claim Representative|State Farm - Austin, Texas|11/2012 - 05/2013
  • Determined liability for new automotive claims within state mandated initial contact laws resulting in a 30 percent decrease of claims not transferring to a critical contact pool . 
  • Detailed coverage's, liability, and reasons for denial of claims to policyholder's, attorneys and third-party providers.
  • Coordinated estimates, repair proposals, and rental services to support claim processing and policyholder needs.
  • Negotiated final claim settlements.
Auto Claims Processor|State Farm - Austin, Texas|03/2012 - 11/2012
  • Completed a 3 month training program resulting in obtaining a state adjuster license.
  • Interviewed claimants, named insured's, and witnesses for pertinent claim information.
  • Analyzed first reports of loss and underlying file material to determine claim validity.
  • Provided exemplary service resulting in a promotion 3 months after obtaining my state adjuster license.


Education
Texas State University|| San Marcos, Texas||USA|2009 Bachelor of Arts: General Studies

Minor in Mass communication, Psychology, and Fashion Merchandising.

El Centro College|| Dallas, Texas|USA Nursing

Courses in Licensed vocational nursing.

3.7 GPA


Licenses

California Property & Casualty, and Life Only Agent: #OL99206. Current.

This resume is created in 7 minutes.
Summary
Organized, independent worker with strong time management skills. Detail-oriented and able to learn new tasks quickly and effectively.
Skills
  • Cooperative team member
  • Outstanding interpersonal skills
  • Strong verbal communication
  • Energetic and organized
  • Microsoft Office, Excel, PowerPoint proficiency
  • Collaborative team member
  • Self motivated
  • Independent worker
Experience
March 2017
to
August 2017
Lava Cantina The Colony, TX Hostess

Located items requested by customers. Assisted co-workers. Assisted diners with seating as needed. Checked patrons' identification to ensure that they met minimum age requirements for consumption of alcoholic beverages. Greeted guests and sat them at tables or in waiting areas. Informed patrons of establishment specialties and features.

September 2016
to
October 2017
Blaze Pizza The Colony, TX Pizza Maker Served fresh, hot food with a smile in a timely manner. Accurately measured ingredients required for specific food items. Carefully maintained sanitation, health and safety standards in all work areas.
May 2016
to
August 2017
Careington Frisco, TX Intern

Worked independently and as part of a team to finish scanning cred files. Documented names into their files. Worked with multiple departments to help complete various projects. Projects included scanning files, researching referrals to help create prospect lists.

September 2015
to
June 2016
Culver's The Colony, TX Cashier Up-sold additional menu items, beverages and desserts to increase restaurant profits. Took necessary steps to meet customer needs and effectively resolve food or service issues. Recorded customer orders and repeated them back in a clear, understandable manner. Promptly reported complaints to a member of the management team.
August 2017
to
November 2018
Careington International Corporation Frisco, TX Claims Processor
  • Prepared necessary paperwork to process discount plan claims.
  • Managed over 80-90 claims each day.
November 2018
to
Current
Careington International Corporation Frisco, TX Member Service Representative
  • Performed in-depth research to answer more complex questions.
  • Built customer confidence by actively listening to their concerns and giving appropriate feedback.
  • Informed customers about sales and promotions in a friendly and engaging manner.
  • Educated customers on product and service offerings.
Education and Training
2017
The Colony High School The Colony, TX, USA High School Diploma Member of Cougar Crew (flag runner), bible study, Journey To Dream, and travel club. Did outstanding work in English class with my outstanding written and communication skills.
This resume is created in 7 minutes.
Professional Summary
To obtain a full time position that will utilize my skills and educational background while allowing the opportunity for advancement. Motivated customer service specialist with over 8 years experience in a fast-paced, team-based environment.
Work History
10/2016 to 10/2017
Payroll/Coordinator Edison Home Health Care New York, United States
  • Maintain payroll information by collecting, calculating and entering data
  • Resolve payroll discrepancies by collecting and analyzing information
  • Communicate with various departments to process pay information and handle questions from supervisors and employees regarding paychecks, time cards and other payroll related issues
  • Follow-up with patients and ensure that the Home Health Aide is satisfying the patients with all their needs
  • Responsible for updating all digital file while making sure that all necessary hard copy documents are present
  • Responsible for maintaining and updating the existing patient files
11/2015 to 10/2016
Member Services Associate Fidelis Care - New York City Regional Office New York, United States
  • Assist members in adjusting their insurance preferences
  • Track, file and input all technical documentation under a high pressure environment
  • Answer any inquiries pertaining to a member benefit and health plan
  • Assist in issue resolution to ensure member satisfaction
  • Politely assisted customers in person and via telephone
  • Ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems on the spot
  • Directed calls to appropriate individuals and departments
07/2013 to 11/2015
Claims Processor LogistiCare Solutions, LLC New York, United States
  • Identify and resolve problems with billing invoice forms
  • Arrange travel for patient hospital discharge
  • Confirm all enrollee New York City Medicaid eligibility using Epaces
  • Assist with Fraud and Abuse department
  • Schedule, modify and cancel reservations as requested
  • Comply with all HIPAA regulations
03/2011 to 07/2013
Customer Service Representative Access-A-Ride Long Island City, NY
  • Process travel scheduling and cancellation request
  • Arrange travel authorizations and accommodations
  • Verify locations of drivers to assist customers with estimated time of arrival of vehicles
  • Defused volatile customer situations calmly and courteously
  • Referred unresolved customer grievances to designated departments for further investigation
Affiliations
Hearts To Hands In Needs, Inc.
02/2017-Present
Skills
  • Dexterous in IDX & Eagle
  • Proficient In Microsoft Office
  • Data Entry
  • Proficient in Facets & Salesforce
  • Fluent in Spanish
  • Exceptional communication skills
  • Efficient Multi-tasker
  • Adroit in ePaces and Insurance Verification
This resume is created in 7 minutes.
Professional Summary
Quality-focused verification specialist offering over 10 years of experience in data processing, claims and transcription.
Skills
  • Medical Terminology
  • Microsoft Office proficiency
  • Billing and coding
  • Insurance eligibility verifications
  • Claims appeal procedures 
  • Dedicated team player​
  • Strong interpersonal skills
  • Time management
  • Results-oriented
  • Meticulous attention to detail
Experience
Call Tracker Analyst
Cigna -HealthSpring Dec 2015 to Current
  • Review calls from customer service representatives regarding durable medical equipment.
  • Research plans and benefits to determine whether or not claims were paid correctly.
  • Correct incorrect information in member benefit record.
  • Responsible for auditing and processing claims where the payment exceeds $10,000.
Refund Check Analyst
Cigna Aug 2015 to Dec 2015
  • Conducted research to determine if the submitted refund or returned check is valid.
  • Composed letters to explain why return check is invalid.
  • Prepared check for deposit 
  • Conducted research to determine if checks were valid. 
Senior Claims Processor
Aug 2010 to Aug 2015
  • Processed durable medical equipment claims while assisting other team members with questions.
  • Participated in training other team members on DME claims.
  • Audited trainees claims for revision. 
Claims Examiner
Cigna Jun 2004 to Aug 2010
  • Compiled statistical information for special reports. 
  • Eliminated outdated records by sending the records to be scanned.
  • Verified that information in the computer system was up-to-date and accurate.
  • Organized billing and invoice data and prepared accounts receivable and expected revenue reports for controllers.
  • Created monthly reports for records, closed terminated records and completed chart audits.
  • Processed confidential medical claims information.
  • Successfully established effective systems for record retention by creating database for daily correspondence tracking.
Team Lead-Sprint PC
Nov 1999 to Mar 2004
  • Supervised a team of up to 27 team members.
  • Monitored incoming calls for quality control
  • Coached team on customer services as well as upselling.
  • Received several awards for team exceeding goals and production metrics.
Education and Training
HealthCare Administration University of Phoenix 2014 HealthCare Administration
This resume is created in 7 minutes.
Professional Summary
Technically-adept professional with a background in psychology. Offering over 3 years of multi-line telephone and data entry experience with advanced knowledge of Microsoft Excel.
Skills
    Typist of over 80 WPM
    Microsoft Office proficiency
    HIPAA compliance
    Background in insurance industry
    Professional phone etiquette

Meticulous attention to detail

Insurance eligibility verifications

Advanced Excel spreadsheet functions

Familiar with medical terminology

Data entry


Education
Bachelor of Arts: Psychology 2011 Green Mountain College - Poultney, VT
  • Summa Cum Laude
High School Diploma: 2008 Shaker High School - Latham, NY
Work History
Claims Processor 04/2016 to Current
Beacon Health Options Latham, NY
  • Entered data into the claims system and adjudicated CMS-1500 and UB-04 claims including corrected and coordination of benefits claims.
  • Processed claims daily exceeding accuracy and production standards, and utilized many advanced functions of Microsoft Excel to increase efficiency.
Customer Service Representative 08/2014 to 04/2016
Davis Vision Inc Latham, NY
    • Answered a steady flow of customer calls from members and providers regarding vision insurance benefits, eligibility, affordable care act plans and medical optometry claims.
    • Promoted in November, 2015 to Customer Service Representative II.
    • Built customer loyalty by placing follow-up calls for customers who expressed concerns about their glasses or contacts.
    • Managed high call volume with tact and professionalism.
Host 10/2013 to 07/2014
Portland Pie Co. Manchester Manchester, NH
  • Greeted customers in the restaurant and assisted diners with seating.
  • Trained hosting staff on correct facility procedures
  • Frequently switched between positions as host, server, expo assistant, and delivery driver to meet company needs.
Partner 02/2012 to 07/2013
Stewart's Shop Rutland, VT
  • Operated cash register using POS computer system, stocked shelves, maintained orderliness of work area.
  • As a keyholder, responded to loss prevention incidents, and ordered products.
  • Responsible for conducting numerous daily audits.
  • Assisted in training new team members.
This resume is created in 7 minutes.
Summary
Diligent self-starter who is well versed in federal and state laws related to the automotive industry with ten years of experience with products, claims, contracts, and compliance.
Skills
  • Excellent Verbal and Written Communication 
  • Contracts
  • Legal Filings
  • Annual Reports
  • Insurance Compliance, Laws and Regulations
  • Confidentiality
  • Legal Research
  • Paralegal
  • Microsoft Office Suite - Microsoft Word, Outlook, PowerPoint and Excel
  • Data Entry
  • Customer Service
  • GAP
  • Drafting Documents
  • Teamwork
Experience
Automobile Protection Corporation - APCO Norcross, GA Compliance Analyst I 06/2014 to Current
  • Prepare and file provider registration renewals.
  • File the renewals of Corporate Annual Reports.
  • Maintain all obligor filings with state regulatory authorities.
  • Secure insurance and other provider registration materials as required by the state.
Compliance Specialist
  • Maintained company licensing.
  • Prepared and filed Vehicle Protection Product provider registration as required.
  • Ensured the regulatory compliance of all administered products and programs.
  • Tracked pending legislation to determine its applicability to products and services.
  • Regularly analyzed and reviewed of all current state rules, statutes, and regulations to ensure compliance.
  • Created and modified generic and state-specific applications as required by state law.
LexisNexis Risk Solutions Alpharetta, GA Associate Credentialing Analyst 11/2012 to 06/2014
  • Met and exceeded daily production goals
  • Analyzed and assessed documentation, agreements, and credentials to ensure compliance with federal, state, and internal regulations.
  • Conducted research to aid in fraud prevention and risk management.
  • Business document and license verification.
Safe-Guard Products International Atlanta, Georgia Claims Administrator/ Claims Processor 10/2007 to 09/2012
  • Provided claims administration and support to three departments handling customer claims related to vehicle service contracts.
  • Initiated, processed and adjudicated claims relating to vehicle thefts, lease wear & tear, and vehicle service contracts.
  • Researched, reviewed and analyzed pending claims to determine validity.
  • Prepared written responses to claims including approvals, denials and requests for additional information.
  • Provided written and verbal communication to all necessary parties related to claim submission, fulfillment, and completion.
Cancellation Processor
  • Assisted customers and dealerships with the cancellation of vehicle service contracts.
  • Processed cancellation requests including scanning/indexing documents, calculating refund amounts and authorizing refund disbursements.
  • Researched and amended dealership information in Contract Management System.
  • Served as back-up Department Manager in Manager's absence.
Hands on Atlanta Atlanta, Georgia Service Coordinator 09/2006 to 06/2007
  • Initiated service learning projects.
  • Assisted students in classroom setting.
  • Facilitated after-school enrichment/tutorial programs.
Education and Training
MSL: Law 2015 Kaplan University, Davenport, IA, USA Master of Science in Legal Studies
Certificate: Paralegal Studies 2008 Emory University, Atlanta, GA, USA Torts, Contracts Law, Georgia Statutes and Codes
Paralegal Certificate August 2008
Course work included: Torts, Contracts Law, Georgia Statutes and Codes Emory University, Atlanta, GA
Bachelors of Arts: English 2006 University of West Georgia, Carrollton, GA, USA
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Professional Summary
Customer service representative with experience in processing claims, maintaining accurate documentation and effective communication. Client-focused Sales representative with 10 + years of providing solutions to customers. Solid understanding of word, excel, quickbooks and powerpoint.  Academic background that focuses on healthcare management, operations management and organizational change. 
Skills
  • Team Liaison
  • Self motivated
  • Strong verbal communications
  • Conflict resolution
  • Extremely organized
  • Data management
  • Process implementation
  • Team leadership
  • Staff development
  • Policy investigation
Work History
06/2015 to 11/2015
Claims Processor The Garden City Group, Inc. Hammond, LA
  • Reviewed claims prepared by processors for quality assurance.
  • Effectively input technical data and processed high volume claims with excellent accuracy and production standards.
  • Accurately categorized and

  • Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims and entered data into documents, records and claims for accountability and maximum productivity to ensure proper payout to claimants.
08/2012 to 12/2012
State Farm Claims Representative Kelly Services, Inc. New Orleans, LA
  • Provided assistance to claim handlers to assist with settling and closing claims.
  • Updated and applied corrections to claims per management. 
  • Analyzed departmental documents for appropriate distribution and filing.
  • Processed outgoing mail
08/2010 to 10/2011
Inside Pharmaceutical Sales Pam Lab Covington, LA
  • Increased sales, promoted product awareness, educated physicians and key Pamlab prescribers.
  • Responsible for continued communication with key customers including physicians, nurses and pharmacist to ensure increased prescriptions of Pamlab products and growth of brand.
  • Followed up with product education and sample availability.
03/2006 to 06/2007
Sales Representative AT&T Hammond, LA
  • Assisted customers with establishing a home phone.
  • Sold cellular phone service, long distance, Direct tv, DSL internet and telephone features such as caller ID, voicemail etc.
  • Assisted customers with technical and billing support. 
  • Achieved and exceeded monthly quotas.
  • Answered an average of 80 calls per day by addressing customer inquiries, solving problems and providing new product information.
  • Answered product questions with up to date knowledge of sales and store promotions.
  • Investigated and resolved customer's inquiries and complaints in a timely, empathetic manner.
08/2005 to 01/2006
Call Center Supervisor Fara Catastrophe Mandeville, LA
  • Liaison for call center and corporate office.
  • Assisted claims adjusters with the closing of insurance claims.
  • Analyzed departmental documents for appropriate distribution and filing.
  • Conducted center meetings, faxing, time sheets, pay raises and hiring.
  • Addressed and resolved customer product complaints empathetically and professionally.
  • Managed customer calls effectively and efficiently in a complex, fast paced and challenging call center environment.
  • Supervised call center employees to ensure customer satisfaction goals were consistently met. 
04/2002 to 06/2003
Sales Representative/ Customer Service Sprint PCS Mandeville, LA
  • Assisted customers with technical and billing support.
  • Sold and activated customer's cellular service.
  • Sold home long distance, cellular phones and accessories.
  • Conducted outbound sales.
  • Achieved monthly quotas each month.
Education
Associate of Science: Business Administration Colorado Technical University - Colorado Springs, CO
Bachelor of Science: Business Administration, Health Care Management Colorado Technical University - Colorado Springs, CO