Helen Sanders
Oklahoma City,OK
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. Enthusiastic about helping patients get necessary medical support by obtaining authorizations, scheduling procedures and coordinating paperwork. Detail-oriented and proactive with good relationship-building skills, a hardworking nature and an adaptable approach. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Processing Clerk
Costco
08.2023 - Current
- Conducted routine audits on submitted claims for accuracy before submission
- Provided excellent customer service by responding promptly to inquiries via telephone and email
- Analyzed data to identify discrepancies in claims information and took corrective action
- Managed multiple tasks simultaneously while meeting established deadlines
- Utilized effective problem-solving skills to resolve inquiries from internal and external customers regarding denied claims or payments
- Processed and tracked claims for accuracy, completeness, and timeliness
- Documented all activities related to claim resolution in an organized manner following departmental protocols
- Demonstrated strong communication skills while interacting with both internal staff and external customers
- Analyzed customer documentation for accuracy and completeness before processing claims.
- Utilized specialized software to process incoming claims, enter data, and generate reports.
- Managed workload and priorities to meet claims processing deadlines.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Followed up with customers on unresolved issues.
- Managed around 30 chats a day, roughly 15 emails a day and took 40-50 calls a day
Senior Customer Service Representative
Principle Choice Solution
12.2021 - 07.2023
- Provided excellent customer service to a diverse range of clients, building strong relationships and ensuring high levels of satisfaction
- Managed 50-plus calls a day, during busy season took as many as 85 calls a day.
- Handled escalated situations calmly while maintaining positive relationships with customers throughout the process
- Demonstrated ability to work independently under minimal supervision while meeting daily objectives and goals set by senior staff members
- Developed in-depth understanding of company products and services, responding promptly to inquiries and resolving issues quickly and efficiently
- Adhered strictly to departmental guidelines related to confidentiality protocols when dealing with sensitive information
- Performed quality assurance checks on call recordings regularly to maintain high standards of service delivery
- Implemented effective communication strategies with customers via phone calls, emails, live chat support
- Maintained current knowledge of healthcare industry trends, new technologies, and government regulations related to claim processing
- Utilized problem-solving skills to resolve claim payment issues for providers promptly
- Provided training and guidance to junior staff regarding proper claim-processing techniques
- Ensured compliance with HIPAA privacy rules when accessing confidential patient information
- Analyzed claim information to ensure the accuracy of data entry before processing
- Developed and maintained strong working relationships with internal and external customers
- Assisted other team members in resolving difficult or unusual claims issues as needed
- Verified insurance coverage by reviewing policies, endorsements, and other documents
- Analyzed customer documentation for accuracy and completeness before processing claims
- Assisted in training new staff members on proper procedures for processing claims
- Updated insurance policies for changes, reinstatements, and cancellations
- Reviewed medical bills and medical records to determine medical necessity and appropriate treatment
- Entered insurance- and claims-related information into database systems
- Reviewed insurance policy to determine coverage
- Provided customer services, such as limited instructions on proceeding with claims and referrals to auto repair facilities and local contractors
- Communicated directly with doctors, veterans, and beneficiaries about claims
- Go over eligibility, OHI certification, transfers, and payment information, and help assisted providers with completing claims correctly, updates, and any questions or concerns.
- Responded to customer calls and emails to answer questions about products and services.
- Resolved customer service issues using company processes and policies and provided updates to customers.
- Trained and directed new employees in call script use, conflict resolution, and data entry practices to boost customer satisfaction ratings.
- Leveraged consistent, successful strategies to meet and exceed performance goals.
- Investigated and resolved customer inquiries and complaints quickly.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Exhibited high energy and professionalism when dealing with clients and staff
- Excellent Q&A scores
Assistant Manager
Freddy's Frozen Custard
07.2020 - 12.2021
- Maintained a high level of professionalism when dealing with difficult customers
- Handled customer complaints and inquiries in a courteous and efficient manner
- Provided exceptional customer service to ensure customer satisfaction
- Demonstrated excellent communication skills, both verbal and written, in order to effectively interact with customers
- Resolved customer complaints promptly and efficiently
- Maintained knowledge of company products to provide helpful suggestions and recommendations to customers
- Recommended improvements in products, services or billing methods to prevent future problems
- Read from scripts to promote uniformity and consistency in communications
- Used job-related software to complete contract forms, prepare change of address records or issue service discontinuance orders
- Built sustainable relationships and trust with customer accounts using open and interactive communication
- Recorded details of inquiries or complaints to maintain up-to-date records of customer interactions and transactions
- Made appropriate account corrections to resolve customer problems
- Navigated multiple computer systems and applications and utilized search tools to find information
- Provided exceptional customer service to clients in fast-paced call center environment
- Gave accurate and appropriate information to answer questions, troubleshoot issues and resolve complaints.
- Supervised day-to-day operations to meet performance, quality and service expectations.
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
- Completed regular inventory counts to verify stock levels, address discrepancies, and forecast future needs.
- Offered hands-on assistance to customers, assessing needs, and maintaining current knowledge of consumer preferences.
- Helped with planning schedules and delegating assignments to meet coverage and service demands.
- Developed loyal and highly satisfied customer base through proactive management of team customer service strategies.
Customer Service Representative
NTT Data
05.2019 - 12.2020
- Trained new employees in product knowledge, customer service protocols, cash handling procedures, and safety regulations
- Resolved customer complaints quickly and effectively while maintaining a high level of professionalism
- Helped oversee daily operations, managing staff and inventory
- Resolved customer complaints and handled refunds and returns to promote satisfaction
- Managed daily operations, including scheduling staff, assigning tasks, and overseeing inventory control processes
- Coached and mentored new employees on company policies and procedures
- Assisted with new employee training and conducted performance reviews to track overall progress
- Tracked store inventories and replenished products according to demand
- Maintained hands-on knowledge of job roles and regularly stepped in to perform business duties
- Established clear communication channels between staff members to ensure smooth workflow throughout the store
- Provided guidance and support to junior staff members during challenging situations
- Oversaw daily financial transactions and managed cash flow to support profitability
- Interviewed potential job candidates and made hiring recommendations to the general manager
- Coordinated employee schedules according to staff availability and processed time-off requests
- Maintained accurate records of sales transactions using point-of-sale systems
- Organized weekly team meetings to discuss progress on projects, review new policies, and motivate employees to reach their goals
- Created weekly schedules based on predicted staffing needs,
- Maintained frequent interaction with senior management to measure goal achievement and determine areas of improvement
- Oversaw personnel to maintain adequate staffing and minimize overtime
- Minimized staff turnover through appropriate selection, orientation, and training.
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly, and escalated major issues to the supervisor.
- Answered a constant flow of customer calls with minimal wait times.
- Managed over 50 calls a day, during the busy season took roughly 70-80 calls a day
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Updated account information to maintain customer records.
- Clarified customer issues and determined the root cause of problems to resolve product or service complaints.
Education
Bachelor in Business Administration -
Southern New Hampshire University
Manchester, NH05.2025
Skills
- Quality Assurance
- Data Entry Proficiency
- Medical Terminology Knowledge
- Adaptability and Flexibility
- Analytical Thinking
- Accuracy and Precision
- Claims Review
- Claims
- Insurance Coverage Verification
- Claims Processing
- Account Management
- Business Administration
- Strategic Planning
- Complex Problem-Solving
- Team Leadership
- Emotional Intelligence
- Computer Skills
- MS Office
- Remote Work Experience
- Administrative Support
- Team Support
- Phone and Email Etiquette
- Paperwork Processing
- Complaint Resolution
- Data Collection
- Documentation
- Problem-Solving Abilities
- Quality Assurance Controls
- Order Processing
- Call Center Operations
- Computer Proficiency
- Computer Literacy
- Follow-up skills
- Analytical thinking
- Insurance verification
- Conflict resolution
- Active listening
- Performance monitoring
- Organizational skills
- Data entry proficiency
- Patient confidentiality
- Problem-solving abilities
- Training and development
- Empathy and compassion
- Claims processing
- Effective communication
- Stress tolerance
- Critical thinking
- Telephone etiquette
- Attention to detail
- Quality assurance
- Call center experience
- Medical terminology knowledge
- Eligibility Determination
- Insurance Verifying
- Document Filing
- Office Administration
- Scheduling Appointments
- HIPAA Compliance
- Contract Development
- Customer Account Management
- Multi-Line Phone Systems
- Data Evaluation
- Inbound Call Management
- Transaction Processing
- Team Development
- Task Prioritization
- Motivational Skills
- Effective Communication
- Decision Making
- Analytical Skills
- Customer Focus
- Team Supervision
- Client Service
- Leading Team Meetings
- Team Check-Ins
- Problem-Solving
- Staff Training
- Data Analysis
- Claims Analysis
- Multitasking Abilities
- Teamwork Abilities
- Insurance Knowledge
- Insurance Claim Forms Review
- Medical Terminology
- Appointment Scheduling
- Documentation Processing
- Claims Adjustment
- Microsoft Office
Certification
Servsafe- Food handler Certification
Contact - Skills
- Excellent attention to detail
- Training Junior Team Members
- Constructive Feedback
- Excellent Administrative Abilities
- Client Support
- Communications Strategies
- Account Management Expertise
- Great Mathematical Skills
- Staff Development
- Business Administration
- Business Planning
- Financial Management
- Staff Supervision
- Staff Training
- Time Management
- Managing Multiple Priorities
- Directing Team Members
- Money Handling
- Closing Oversight
- Recruiting and Interviewing
- Product and Service Knowledge
Assessments
- Administrative assistant/receptionist, Proficient, 08/01/21, Using basic scheduling and organizational skills in an office setting
- Work motivation, Proficient, 06/01/23, Level of motivation and discipline applied toward work
- Work style: Reliability, Proficient, 11/01/22, Tendency to be reliable, dependable, and act with integrity at work
- Call center customer service, Proficient, 07/01/22, Demonstrating customer service skills in a call center setting
- Customer service, Proficient, 07/01/20, Identifying and resolving common customer issues
- Attention to detail, Proficient, 07/01/22, Identifying differences in materials, following instructions, and detecting details among distracting information
References
References available upon request
About me
I want the most out of life and I believe that making memories and expansion of ones skills and mindset is the best way to achieve a good life. For me that means being as positive as I can and try to make a difference even the small ones matter. My kids mean the most to me and everything I do is to give them a good life and show them with hard work and dedication what they believe in and wish for can be achieved. I enjoy reading, improving my skills and spending time with my kids, we enjoy being outdoors,riding horse, swimming, going to the park, trying new foods, doing arts and crafts, experiments and traveling.
Timeline
Claims Processing Clerk
Costco
08.2023 - Current
Senior Customer Service Representative
Principle Choice Solution
12.2021 - 07.2023
Assistant Manager
Freddy's Frozen Custard
07.2020 - 12.2021
Customer Service Representative
NTT Data
05.2019 - 12.2020
Bachelor in Business Administration -
Southern New Hampshire University
Servsafe- Food handler Certification
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