James Wagner
LAS VEGAS
Summary
Dynamic Provider Services Representative with a proven track record at Las Vegas Urban League, excelling in claims processing and HIPAA compliance. Recognized for enhancing provider satisfaction through effective communication and problem-solving. Achieved timely resolution of inquiries, fostering strong relationships and streamlining operations in a fast-paced healthcare environment.
Overview
10
10
years of professional experience
Work History
Provider Services Representative
Las Vegas Urban League
01.2025 - Current
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Acted as a liaison between providers and company leadership, effectively communicating concerns and feedback to facilitate continuous improvement initiatives.
- Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
Driver
CrossRoads Courier
07.2024 - 01.2025
- Followed all relevant traffic laws and safety regulations.
- Utilized GPS and other navigation tools to plan routes and stay on schedule.
- Achieved safe driving records by consistently following traffic rules and regulations.
- Delivered goods and products to customer on time and in excellent condition.
- Cleaned and maintained vehicle and assessed vehicle for damage after each shift.
- Maintained accurate delivery records, ensuring all packages were accounted for and delivered to the correct recipients.
Provider Services Representative
Las Vegas Urban League
01.2024 - 07.2024
- Improved communication between providers and insurance companies, leading to better understanding of policy coverage and claim status.
- Increased efficiency by accurately entering provider data into company systems and databases.
- Promoted positive relationships between the organization and its network providers through timely responses to inquiries and effective issue resolution.
- Served as a reliable resource for both internal staff and external partners, offering guidance on best practices in managing provider relationships.
- Ensured compliance with regulatory requirements by conducting thorough audits of provider files and documentation.
Claims Representative
Aston Carter
12.2019 - 08.2023
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
- Minimized financial losses by identifying fraudulent claims through thorough analysis and investigation.
- Conducted detailed investigations into suspicious claims, reducing instances of fraud.
Customer Service Representative
Asurion
05.2017 - 09.2018
- 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.
Customer Service Representative
SYKES
09.2015 - 05.2017
- Built rapport with customers through empathetic listening and understanding their unique needs or preferences.
- Increased customer satisfaction by addressing and resolving complex issues effectively.
- Managed high call volume, ensuring timely response and effective resolution to all customer concerns.
- Reduced wait times through efficient call handling, enhancing overall customer satisfaction rates.
- Contributed to positive team culture, driving motivation and productivity among peers.
- Delivered exceptional service by consistently meeting or exceeding performance metrics for quality, speed, and accuracy.
Education
GED -
Stanley Online High School
01-2022
Skills
- HIPAA compliance
- Claims processing
- Goal-oriented mindset
- Call center experience
- Data entry proficiency
- Healthcare industry
- Problem-solving
Timeline
Provider Services Representative
Las Vegas Urban League
01.2025 - Current
Driver
CrossRoads Courier
07.2024 - 01.2025
Provider Services Representative
Las Vegas Urban League
01.2024 - 07.2024
Claims Representative
Aston Carter
12.2019 - 08.2023
Customer Service Representative
Asurion
05.2017 - 09.2018
Customer Service Representative
SYKES
09.2015 - 05.2017
GED -
Stanley Online High School
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