Jazmen Flemming
Jacksonville
Summary
Efficient Claims Benefit Specialist known for productivity and swift completion of tasks. Skilled in navigating complex insurance claims, interpreting policy coverage, and advocating for client benefits. Excel at communication, problem-solving, and time management, ensuring seamless operations and client satisfaction.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
An organized and motivated individual, eager to utilize time management and organizational skills across diverse settings. Seeking entry-level opportunities to enhance abilities while contributing to company growth.
Overview
15
15
years of professional experience
1
1
year of post-secondary education
1
1
Certification
Work History
Claim Benefit Specialist Ops
Aetna/CVS Health
Work From Home
04.2022 - Current
- Reviews and adjudicates routine claims in accordance with claim processing guidelines.
- Applies medical necessity guidelines, determines coverage, complete eligibility verification, identify discrepancies and applies all cost containment measures to assist in the claim adjudication process.
- Proofs claim or referral submission to determine, review or apply appropriate guidelines, coding, member identification process, diagnosis and pre-coding requirements.
- Utilizes all applicable system functions available ensuring accurate and timely claim processing services (i.e. utilizes claim check, reasonable and customary data, and other post-containment tools).
Customer Service Advisor
JEA
Jacksonville
08.2020 - 04.2022
- Respond to and process customer in-bound phone and written inquiries to include: Assisting customers with billing inquiries utilizing the customer billing system, MDMS, Utility Tracker and other available systems and data.
- Promote relevant JEA services, products and solutions that could benefit the customer.
- Completes all necessary actions to resolve the customer's need, including but not limited to: updating systems or applications, outage reporting and status updates, creating cases, and/or escalating cases to other groups or individuals.
- Ensures compliance with audit and regulatory procedures and adherence to compliance guidelines.
- Handles simple customer escalations and dispute cases.
- Performs other job-related duties as assigned within the job scope or subordinate positions within the job series.
Office of the President Agent
Enhanced Resource Centers
Jacksonville
08.2018 - 08.2020
- Addressing escalated calls and situations in real time if a supervisor is not able to readily and easily resolve a consumer’s inquiry, thus allowing our Team Supervisors, Operations Managers, and Directors to focus mainly on production.
- Researches all internal consumer complaints and escalations received via Phone, Customer Care, ERC Help, Correspondence, or any other intake channel available to consumers.
- Speaks with consumers to address highly escalated items and provides solutions in the event Operations needs assistance while remaining within legal guidelines and client SLA.
- Addresses agents compliance and works with Quality Assurance to provide factual data or Operations via Investigation Advisories with Operations.
- Completes specific escalations or consumer complaints and ensures proper research is conducted and factual data is provided, while within client SLA (required time frames).
Market Research/Outsourcing/Recovery Agent
Enhanced Resource Centers
Jacksonville
04.2017 - 08.2018
- Answers inquiries by clarifying desired information; researching, locating, and providing information.
- Resolves problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
- Make outbound telephone calls to customers informing them of their delinquent account.
- Treat our customers with respect, empathize with their situation, and identify a win-win outcome for both the customer and the clients we service.
- Think outside of the box to negotiate the best possible arrangement.
- Performance is based on daily call volume/effective resolution compared to assigned monthly goals.
- Follow standardized processes and procedures for executing the survey interview and capturing clear and accurate data.
Customer Service Representative
AT&T Mobility (Call Center)
Fayetteville
01.2016 - 09.2016
- Answers inquiries by clarifying desired information; researching, locating, and providing information.
- Resolves problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
- Fulfills requests by clarifying desired information; completing transactions; forwarding requests.
Server
Mikoto Japanese Steakhouse
Fayetteville
07.2015 - 10.2015
- Processing payment.
- Greeting customers.
- Cleaning tables and dining area.
Sales Associate
Rainbows Retail Clothing Store
Hinesville
04.2015 - 07.2015
- Greet customers and determine their needs and wants.
- Prepared sales contracts and accepted payment through cash and credit card.
- Assisted in display of merchandise.
Recruiter I
Acosta Sales & Marketing
Jacksonville
04.2014 - 09.2014
- Source and attract candidates by using databases, social media etc.
- Screen candidates resumes and job applications.
- Conduct interviews using various reliable personnel selection tools/methods to filter candidates within schedule.
Residential Sales Representative
ADT Security Services (Call Center)
Jacksonville
03.2013 - 03.2014
- Answers Inbound residential customer calls; calls must be handled in a timely and professional manner and in accordance with company policies and procedures.
- Responds to customer complaints in a professional manner; attempts to resolve complaints successfully and up sell in accordance with established guidelines.
Sales Associate
Kohls Department Store
Jacksonville
10.2011 - 12.2013
- Greet customers and determine their needs and wants.
- Prepared sales contracts and accepted payment through cash and credit card.
- Assisted in display of merchandise.
Customer Service Representative
Convergys
Jacksonville
11.2012 - 02.2013
- Answers inquiries by clarifying desired information; researching, locating, and providing information.
- Resolves problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
- Sells additional services by recognizing opportunities to up-sell accounts; explaining new features.
Education
Master of Science - Human Resources
American Public University Service (APUS)
08.2025 - 05.2026
Bachelor’s - Human Resources Management
American Public University Service (APUS)
Diploma -
Orange Park High School
Orange Park, FloridaSkills
- Customer service
- Training
- Data entry
- Research
- Call handling
- Auditing
- Compliance assessment
- Able to adapt quickly to change and implement updates according
- Work in a team environment
- Ability to establish rapport and build relationships via phone in a high volume environment
Certification
Fayetteville Technical Community College, Effective Teaching Training for Substitutes and Teacher Assistants, 11/15, Present
References
References are available on request.
Timeline
Master of Science - Human Resources
American Public University Service (APUS)
08.2025 - 05.2026
Claim Benefit Specialist Ops
Aetna/CVS Health
04.2022 - Current
Customer Service Advisor
JEA
08.2020 - 04.2022
Office of the President Agent
Enhanced Resource Centers
08.2018 - 08.2020
Market Research/Outsourcing/Recovery Agent
Enhanced Resource Centers
04.2017 - 08.2018
Customer Service Representative
AT&T Mobility (Call Center)
01.2016 - 09.2016
Server
Mikoto Japanese Steakhouse
07.2015 - 10.2015
Sales Associate
Rainbows Retail Clothing Store
04.2015 - 07.2015
Recruiter I
Acosta Sales & Marketing
04.2014 - 09.2014
Residential Sales Representative
ADT Security Services (Call Center)
03.2013 - 03.2014
Customer Service Representative
Convergys
11.2012 - 02.2013
Sales Associate
Kohls Department Store
10.2011 - 12.2013
Bachelor’s - Human Resources Management
American Public University Service (APUS)
Diploma -
Orange Park High School