Jessica F Nelson
Tampa
Summary
Detail-oriented professional with experience reviewing and processing claims, maintaining accurate records, and ensuring compliance with company policies and procedures. Skilled in data entry, document verification, customer communication, and problem resolution. Proven ability to work independently in a remote environment while meeting productivity, quality, and turnaround-time goals.
Overview
10
10
years of professional experience
Work History
Medicare ISG Agent (Claims, DME, Supervisory Agent)
Maximus Federal
2020.07 - 2026.06
- Handle inbound calls to educate beneficiaries on Medicare Advantage, Supplement, and Prescription Drug plans.
- Handle live call monitoring and assistance to peers that need to find correct scripting.
- Use scripts and compliant talking points approved by CMS (Center for Medicare & Medicaid Services).
- Clarify eligibility, benefits, and enrollment periods.
- Escalating complex cases to specialized departments when needed.
- Providing education and resources to help beneficiaries understand their healthcare options.
- Following guidelines established by the Centers for Medicare & Medicaid Services (CMS).
- Streamlined communication channels between departments, improving collaboration and efficiency.
- Mentored junior agents, fostering professional development and knowledge sharing.
- De-escalated and resolved customer complaints with punctual, polite and professional service.
- Enhanced client satisfaction by promptly addressing inquiries and providing accurate information on services.
Acting Trainer
Maximus Federal
2025.06 - 2025.12
- Conduct classes for Contact Center Customer Service Representatives for both Medicare and Marketplace.
- Coach agents on call handling, CMS-approved scripts, compliance standards, and customer service best practices.
- Support onboarding by reinforcing product knowledge, systems navigation, and call center procedures.
- Partner with leadership to identify training gaps and help improve team readiness and quality outcomes.
- Supervise and report on progress of trainees and personnel during training period, nesting and while on the floor.
- Identify performance issues, provide corrective action and suggest termination for Customer Service Representatives not meeting performance criteria in the training class.
- Mentored emerging talent, providing constructive feedback to refine techniques and confidence.
- Implemented innovative rehearsal methods to optimize practice efficiency and effectiveness.
- Collaborated with directors to align coaching approaches with production vision and objectives.
Medical Claims Analyst
Humana
2016.08 - 2020.07
- Reduced claim denials and rejections by conducting thorough audits and addressing discrepancies prior submission.
- Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
- Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
- Safeguarded sensitive patient data through strict adherence to HIPAA guidelines and implantation of secure record-keeping practices.
- Met daily productivity and quality targets in a remote work environment.
- Improved billing accuracy by implementing stringent quality control measures and enhancing documentation processes.
- Collaborated with insurance providers to expedite claims processing and secure timely payments for services rendered.
Education
HS Diploma -
Atlantic College
Freeport, Grand Bahama06.2004
Skills
- Claims Processing
- Claims Review
- Document Verification
- Case Management
- Microsoft Excel
- Accuracy
- HIPAA Awareness
- Quality Assurance
- Time Management
- Database & CRM Systems
- Written & Verbal Communication
- Confidential Information Handling
Timeline
Acting Trainer
Maximus Federal
2025.06 - 2025.12
Medicare ISG Agent (Claims, DME, Supervisory Agent)
Maximus Federal
2020.07 - 2026.06
Medical Claims Analyst
Humana
2016.08 - 2020.07
HS Diploma -
Atlantic College