Detail-oriented Customer Service Representative experienced in processing diverse insurance claims while ensuring regulatory compliance. Delivered exceptional customer service through strong attention to detail and analytical skills, leading to expedited resolutions and accurate record maintenance. Focused on optimizing processes and supporting team objectives in fast-paced environments.
Overview
15
15
years of professional experience
Work History
Claims Processor
Blue Cross Blue Shield
10.2025 - Current
Supported veterans, providers, and doctors in processing claim payments and verifying HIPAA compliance, ensuring accurate and timely medical claim account information.
Processed medical claims efficiently, ensuring adherence to regulatory compliance and internal policies.
Reviewed and analyzed claims for accuracy, resolving discrepancies promptly to maintain workflow continuity.
Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
Researched and resolved complex medical claims issues to support timely processing.
Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Verified patient insurance coverage and benefits for medical claims.
Customer Service Representative
Medical Transportation Management
11.2024 - 05.2025
Summarize your key responsibilities and accomplishments. Where appropriate, use the language and words found in the specific job description. Be concise, targeting 3-5 key areas.
Resolved customer inquiries efficiently using CRM software to enhance satisfaction and retention.
Processed orders and managed account updates with precision, ensuring accuracy in customer data.
Streamlined scheduling processes using advanced routing software to optimize resource allocation.
Collaborated with healthcare providers to assess patient needs and improve service delivery.
Coordinated with healthcare professionals to ensure seamless transfer of patients between facilities.
Educated patients and their families on the importance of adhering to pre-transport requirements, such as fasting guidelines or medication schedules.
Customer Service Agent
Access2Care
09.2020 - 11.2024
Welcomed callers warmly and executed daily operations and found resolutions. Operated switchboard, delivering prompt and accurate answering services.
Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
Utilized strong problem-solving skills to quickly identify and address customer issues.
Maintained a high level of professionalism when interacting with customers, ensuring positive experiences.
Addressed customer account discrepancies and concerns.
Responded proactively and positively to rapid change.
Customer Service Representative
Sykes Enterprises, Incorporated
03.2011 - 10.2013
Summarize your key responsibilities and accomplishments. Here again, take any opportunity to use words you find in the job description. Be brief.
Led initiatives for quality assurance, monitoring call metrics to maintain high standards of service excellence.
Managed a high volume of calls daily, maintaining composure under pressure while providing exceptional service.
Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
Demonstrated excellent multitasking abilities by simultaneously handling multiple tasks such as navigating systems, taking notes on calls, and answering inquiries from clients.
Adhered to company policies and scripts to consistently achieve call-time and quality standards.
Cosmetologist
JC Penny Stores
04.2014 - 2016
Provided personal hair services to clients.
Provided personalized consultations to clients for hair, skin, and nail services.
Maintained cleanliness and organization of workstations to ensure compliance with sanitation standards.
Engaged with clients to build lasting relationships, enhancing their overall salon experience.
Collaborated with team members to streamline service delivery and improve client satisfaction rates.
Booked appointments, answered phones, greeted clients, handled payments, and created client service tickets.
Processed payments, entering sales in register for prompt customer service.
Assisted in inventory management by tracking product usage, reordering supplies as needed, and maintaining an organized workspace.
Education
Business Administration Degree - Business Administration
Southern New Hampshire University
08-2025
Cosmetology - undefined
Virginia College
01-2014
High School Diploma - undefined
Wilson High School
01-2002
Skills
Microsoft Word, PowerPoint, Excel, OneNote applications, Microsoft Outlook, Communication skills, Customer Service, and comprehensive training
Analytical thinking
Claims management
Organization
Teamwork
Claims processing
Leadership
Creativity
Interpersonal skills
Professional ethics
comprehensive training
Accomplishments
Resolved product issue through consumer testing.
Used Microsoft Excel to develop inventory tracking spreadsheets.
Interests
Enjoying the art of baking and pastry-making, experimenting with recipes
I like working with my hands and fixing things
Cooking
I enjoy helping others and giving back to the community
Gardening
Gym Workouts
Reading
Personal Development and Self-Improvement
Timeline
Claims Processor
Blue Cross Blue Shield
10.2025 - Current
Customer Service Representative
Medical Transportation Management
11.2024 - 05.2025
Customer Service Agent
Access2Care
09.2020 - 11.2024
Cosmetologist
JC Penny Stores
04.2014 - 2016
Customer Service Representative
Sykes Enterprises, Incorporated
03.2011 - 10.2013
High School Diploma - undefined
Wilson High School
Cosmetology - undefined
Virginia College
Business Administration Degree - Business Administration