Summary
Overview
Work History
Education
Skills
Timeline
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Adrianna Jackson

Houston

Summary

Detail-oriented and customer-focused Customer Service & Claims Specialist with 5+ years of experience in claims processing, customer retention, and data entry. Skilled in handling high-volume inbound calls, data verification, fraud detection, and benefits administration. Resolving customer concerns, processing claims efficiently, and ensuring compliance with company policies. Strong analytical skills with expertise in CRM software, Microsoft Office Suite, and claims management systems.

Overview

10
10
years of professional experience

Work History

Claims Processor

BCFORWARD
06.2021 - 03.2025
  • Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
  • Process and verify claims submissions, benefits eligibility, and policyholder information with accuracy.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
  • Handle high-volume inbound calls while providing first-call resolution (FCR) to customers.
  • Investigate potential fraud cases, ensuring compliance with company policies and regulatory standards.
  • Maintain and update customer records in CRM systems, ensuring proper documentation and accuracy.
  • Collaborate with internal departments to expedite claim resolutions and improve workflow efficiency.

Customer Service Specialist

EZ TAG STOREFRONT
01.2020 - 04.2021
  • Assisted customers with billing issues, toll violations, and account management.
  • Used CRM software to track and resolve customer service inquiries efficiently.
  • Ensured quality assurance by auditing customer accounts and identifying discrepancies.
  • Provided in-person customer support, resolving escalated concerns and enhancing customer satisfaction.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Investigated and resolved customer inquiries and complaints quickly.

Retention Specialist

AT&T
11.2018 - 10.2019
  • Retained customers by offering tailored solutions and upselling relevant products and services.
  • Resolved escalated customer complaints, improving customer loyalty and reducing churn rates.
  • Analyzed customer data to identify patterns and improve retention strategies.
  • Handled escalated customer complaints professionally, de-escalating situations while finding mutually beneficial resolutions.
  • Enhanced customer satisfaction levels with proactive communication and timely resolution of issues.
  • Negotiated contract renewals, securing continued business partnerships with satisfied clients.


Customer Service Representative

CVS Caremark
10.2014 - 09.2018
  • Managed customer inquiries related to prescription benefits, coverage, and order processing.
  • Entered and updated customer data into the system while maintaining HIPAA compliance.
  • Identified priority issues, escalating cases as needed for resolution.
  • Provided product and service information while ensuring exceptional customer service.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
  • Responded to customer requests for products, services, and company information.

Education

Charlottesville High School
Charlottesville, VA

Skills

  • Claims review
  • Accuracy and precision
  • Transactions reconciliation
  • Claims Processing & Verification
  • Data Entry & Accuracy
  • Customer Service & Support
  • Fraud Detection & Risk Mitigation
  • CRM Software (Salesforce, EPIC)
  • Insurance Policy & Benefits Administration
  • Quality Assurance & Compliance
  • Document Management & Reporting
  • Problem Resolution & Conflict Management
  • Multi-tasking & Time Management

Timeline

Claims Processor

BCFORWARD
06.2021 - 03.2025

Customer Service Specialist

EZ TAG STOREFRONT
01.2020 - 04.2021

Retention Specialist

AT&T
11.2018 - 10.2019

Customer Service Representative

CVS Caremark
10.2014 - 09.2018

Charlottesville High School

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Adrianna Jackson