JAMES MYERS
Augusta
Summary
Claims and escalations-focused customer service professional with experience supporting members and patients in high-volume environments. Skilled in eligibility verification, case research, documentation, and resolving time-sensitive issues with calm professionalism. Comfortable handling complex inquiries, de-escalating concerns, and coordinating next steps while maintaining HIPAA compliance and strong quality metrics.
Overview
5
5
years of professional experience
Work History
Claims & Escalations Specialist
Modivcare
05.2024 - 01.2026
- Managed high-volume member inquiries related to non-emergency medical transportation, eligibility, trip details, and service issues; resolved concerns quickly and professionally.
- Handled escalations involving delays, reroutes, and critical-care requirements, coordinating accurate next steps and setting clear expectations.
- Protected sensitive personal and medical information by following HIPAA guidelines and documenting cases with audit-ready accuracy.
- Utilized CRM/transportation platforms to log updates, track outcomes, and maintain strong quality metrics and customer satisfaction.
- Via Arise Virtual Solutions
Guest Advocate (Front of Store Attendant)
Target
Aiken
06.2021 - 12.2023
- Delivered a guest-first experience by greeting customers, answering questions, and resolving concerns at the front of store.
- Processed transactions efficiently and accurately while maintaining compliance with store policies and food safety best practices.
- Used store tools and product knowledge to solve issues, improve the guest experience, and support quick resolution on the floor.
- Maintained a welcoming environment and supported team operations during peak volume periods.
- Aiken, SC
Education
High School Diploma - ntroduction to Business I & II
Evans High School
Evans, GACompTIA A++ -
Aiken technical
Skills
- Claims Support & Escalation Handling
- CRM/Ticketing & Multi-System Navigation
- Eligibility Verification & Intake
- Problem Solving Under Pressure
- High-Volume Inbound Calls
- Scheduling & Service Coordination
- De-escalation & Service Recovery
- Customer Communication & Empathy
- Accurate Case Documentation
- Time Management & Multitasking
- HIPAA & Confidentiality
- Remote Work Performance
Additional Information
Work-from-home ready with a quiet, dedicated workspace and reliable high-speed internet. Comfortable using CRM platforms, call-handling tools, and Microsoft Office. Recognized for professionalism, accuracy, and consistent performance in high-volume support roles.
Timeline
Claims & Escalations Specialist
Modivcare
05.2024 - 01.2026
Guest Advocate (Front of Store Attendant)
Target
06.2021 - 12.2023
High School Diploma - ntroduction to Business I & II
Evans High School
CompTIA A++ -
Aiken technical