Jacob Franco
Riverview,FL
Summary
Looking to further cultivate my love and interest for helping people in conjunction with computers and technology in a professional work environment.
Overview
13
13
years of professional experience
Work History
Medical Claims Examiner
Imagenet
01.2021 - Current
- Reviewed and adjudicated hospital claims to align with coverage benefits and contractual rates across various health plans, ensuring accurate processing.
- Examined claims for compliance with contractual criteria, including timely submission, appropriate place of service and bill type, and proper authorization for services rendered.
- Utilized claims processing software to enter, track, and manage claims efficiently.
Central Loss Reporting Unit
Progressive
01.2018 - 01.2021
- Managed high workload and call volume, effectively addressing escalated customer issues over extended periods.
- Deescalated stressful situations for callers while coordinating additional services such as tow dispatches and auto rentals.
- Assisted customers with filing new losses and following up on existing losses, ensuring a professional and empathetic experience.
Billing Specialist
EMSI
05.2016 - 01.2018
- Data Entry and Billing role working with billing Insurance carriers for units and products prescribed by doctors.
- Knowledge of HCPC codes and utilization of correct diagnosis codes per insurance policy guidelines prior to submitting claims.
- Submitted tickets for software issues and resolved technical problems for users.
Customer Service Representative/Supervisor
Florida Blue
06.2015 - 05.2016
- Worked as Call Center Representative assisting with general inquiries, payments, and basic account resolution.
- Experienced with large call volume with back to back calls throughout the work day.
- Promoted soft sales such as enrolling in auto draft and recommending Policy changes based on needs of the customer.
- Assisted in training other classes of new hires of how to properly handle calls per company guidelines.
- Worked specifically on large volume of account resolution cases when not on the phone.
- Experience working in supervisory role, taking escalated calls in order to deescalate and find solutions.
- Assisted customer service representatives on difficult cases and coached and instructed on how to improve customer quality relations.
Warehouse Associate
Good Roads Auto Center
09.2014 - 06.2015
- Primary responsibility was to stock product of rims and wheels and deliver to customers and other Auto Dealers.
Warehouse/Customer Service
Sears
01.2014 - 09.2014
- Assisted customers both in person and on the phone regarding product inquiries and delivery arrangements.
- Promoted soft sales in the form of extended warranties for newly purchased items or the renewal of warranties for products sent in for repair.
- When not assisting customers, primary role was to stock and replenish low supply.
Education
High School Diploma -
Florida Virtual School
Computer Support Specialist Program -
HCC
Skills
- Claims adjudication
- Insurance claims processing
- Benefit verification
- HIPAA compliance
- Quality assurance
- Data entry accuracy
- Attention to detail
- Team collaboration
- Conflict resolution
Personal Information
Date of Birth: 09/28/92
Availability
Can begin within two weeks of notice
Goals And Interests
- I Love to work with computers and interact with others including both peers and clientele.
- I hope to continue to find a career path that allows me to show my love and interest for growing technology and allow me to help others in any way I can.
Qualification Overview
- Experience with medical claim adjudication and billing as well as a good understanding of Ub-04's, Rev codes, diagnosis codes, HCPC (Cpt codes), bill types and place of service codes.
- Able to focus on large volume of tasks while focusing on those of the highest priority for extended periods of time.
- Prior Call Center Experience
- Excellent customer service skills
- Strong belief to provide the best quality service that I can provide for any assignment.
- Trustworthy and honest
- Great communication skills due to what's involved in volunteer work that I participate in.
- Loves to overcome problems and find solutions
- Can sympathize and empathize with others to personal level.
- Proficient and efficient with technology in general especially computers.
- Great understanding of claims especially in relation to Auto Claims
Timeline
Medical Claims Examiner
Imagenet
01.2021 - Current
Central Loss Reporting Unit
Progressive
01.2018 - 01.2021
Billing Specialist
EMSI
05.2016 - 01.2018
Customer Service Representative/Supervisor
Florida Blue
06.2015 - 05.2016
Warehouse Associate
Good Roads Auto Center
09.2014 - 06.2015
Warehouse/Customer Service
Sears
01.2014 - 09.2014
High School Diploma -
Florida Virtual School
Computer Support Specialist Program -
HCC