Clarrissa Rutledge
Riverdale,Illinois
Summary
Detail-oriented and client-focused Taxpayer Information Specialist II candidate with 3+ years of experience in claims processing, customer service, and policy interpretation. Skilled at analyzing complex information, ensuring legal compliance, and providing accurate and efficient support to customers. Adept at handling confidential information with integrity and resolving inquiries with a strong focus on accuracy and service excellence. Proficient in Jacada and OnBase with a proven ability to collaborate in a team environment while maintaining high individual performance standards.
Overview
9
9
years of professional experience
Work History
Claims Resolution Specialist
United Healthcare Group
Riverdale, Illinois
09.2022 - Current
- Investigate and verify claims information to determine eligibility, settlement amounts, and compliance with applicable policies and regulations.
- Conduct interviews with agents and claimants to resolve discrepancies, and document findings accurately.
- Calculate claims amounts in accordance with policy data, coverage limitations, and regulatory standards.
- Review supporting documentation to validate claims accuracy, ensuring compliance with legal and company guidelines.
- Collaborate with management and external stakeholders to justify reserve recommendations and settlement decisions.
- Analyze claim handling processes to identify trends, resolve root causes, and improve operational efficiency.
- Maintain detailed records of claim activities in Jacada and OnBase systems.
- Provide guidance to peers in managing complex or high-risk claims to ensure consistent application of policies.
- Reconciled accounts receivable balances against payment records on a regular basis.
Associate Claims Representative
United Healthcare Group
Riverdale, Illinois
02.2019 - 09.2022
- Evaluated insurance policy terms to accurately calculate premiums, commissions, and coverage adjustments.
- Reviewed and interpreted insurance coverage to determine policy limits for claims processing.
- Entered and maintained claims data within Jacada and OnBase, ensuring accurate and timely documentation.
- Prepared and audited insurance claim forms for completeness and compliance with established procedures.
- Communicated with insured parties to gather additional information and clarify discrepancies.
- Updated internal databases to reflect newly filed and ongoing claims, supporting accurate tracking and reporting.
Customer Service Representative
Medical Transportation Representative
Charleston, WV
05.2016 - 02.2019
- Delivered high-quality customer service by answering inquiries regarding policies, procedures, and service offerings.
- Met and exceeded personal, team, and organizational goals within a high-volume service environment.
- Collaborated with internal departments to address and resolve customer concerns promptly and professionally.
- Handled sensitive customer inquiries, payments, and service requests with confidentiality and attention to detail.
- Maintained comprehensive documentation of customer interactions to support accurate reporting and quality assurance initiatives.
- Consistently anticipated customer needs and provided proactive solutions to enhance service satisfaction.
Education
Associate in Science (A.S.) - Respiratory Therapy
Bridgemont Community and Technical College
South Charleston, West VirginiaSkills
- Customer Service Excellence
- Conflict Resolution and Problem Solving
- Policy and Procedure Interpretation
- Records Management and Documentation
- Legal and Regulatory Compliance
- Data Verification and Accuracy
- Decision Making and Critical Thinking
- Effective Public Communication
- Confidential Information Handling
- Familiarity with Insurance and Tax-related Terminology
Timeline
Claims Resolution Specialist
United Healthcare Group
09.2022 - Current
Associate Claims Representative
United Healthcare Group
02.2019 - 09.2022
Customer Service Representative
Medical Transportation Representative
05.2016 - 02.2019
Associate in Science (A.S.) - Respiratory Therapy
Bridgemont Community and Technical College