JENNIFER JACKSON
Learning and Development Specialist
Pittsburgh,Pennsylvania
Summary
Successful Corporate Trainer skilled at developing, implementing and optimizing corporate training programs. Data-driven leader with hardworking approach and clear focus on strengthening companies from inside out. Successful integrating multimedia strategies to diversify instruction and maximize success.
Overview
19
19
years of professional experience
Work History
Sr. Commercial Claims Examiner
UPMC Health Plan
Pittsburgh, PA
09.2016 - 06.2024
- Trained and coached members of dental, web teams on best practices to improve quality and production metrics 3 times per week per team member and 5 days per week for general assistance.
- Managed communication from vendors, plan members, providers to ensure claim processing accuracy.
- Processed 135 claims on average daily with 100% accuracy to provide seamless customer service experience.
- Initiated communication with different departments in order to properly request assistance with claims handling to stay in compliance with all Medicare, Medicaid, Commercial guidelines.
- Adhered and remained abreast of all HIPAA guidelines to ensure patient privacy.
- Archived shared data to create databank of resources for future use by all team members.
- Followed department guidelines on reporting of trends pertaining to system functions, claims operations, hold resolution guide conflicts and offered suggestions for improvements/solutions to challenges.
- Evaluated and investigated assigned claims to recommend workflows, alternate decisions and improvements to future claims handling.
- Adjusted reserves to maintain consistency with established operational and risk guidelines.
- Kept team operating with efficient approach, including timely contact with insured and claimants, professional support and thorough work.
- Finalized medical files for insurance claim payment release.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
SENIOR CUSTOMER
SERVICE REP, ALLEGHENY HEALTH NETWORK
Pittsburgh, Pa
03.2015 - 07.2016
- Manage calls from patients daily and answer questions regarding policies and procedures.
- Coordinate scheduling between patients and physician office – performed approximately 30 – 40 times per day.
- Provide employees with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes 10% of 10 hour work day.
- Research physician qualifications and compare against scheduling protocols.
- Implement corporate or departmental policies, procedures, and service standards in conjunction with management.
- Train or instruct employees in job duties or company policies or arrange for training to be provided 20% of work day.
- Coordinate activities with other supervisory personnel or with other work units or departments.
- Participate in the work of subordinates to facilitate productivity or to overcome difficult aspects of work.
- Provided professional services and support in a dynamic work environment.
- Cultivated interpersonal skills by building positive relationships with others.
SENIOR CUSTOMER ADVOCATE
VERIZON WIRELESS
Cranberry Twp, Pa
04.2007 - 05.2014
- Resolve and handle 45-50 calls from customer complaints per day or answer customers' questions regarding policies and procedures.
- Provide employees with guidance in handling difficult or complex problems or in resolving escalated complaints or disputes 10% of 10 hour work day.
- Implement corporate or departmental policies, procedures, and service standards in conjunction with management.
- Discuss job performance problems with employees to identify causes and issues and to work on resolving problems 10% of work day.
- Train or instruct employees in job duties or company policies or arrange for training to be provided 20% of work day.
- Coordinate activities with other supervisory personnel or with other work units or departments.
- Participate in the work of subordinates to facilitate productivity or to overcome difficult aspects of work.
GED INSTRUCTOR, FORBES ROAD CTC
Monroeville, Pa
03.2006 - 04.2007
- Adapt teaching methods and instructional materials to meet 20 students' varying needs, abilities, and interests.
- Observe and evaluate 25 students' work per quarter work to determine progress and make suggestions for improvement.
- Jennifer Jackson 4127169274 jacksonjennifer272@gmail.com Page 2 Professional Experience Continued.
- Plan and conduct activities for a balanced program of instruction, demonstration, and work time that provides students with opportunities to observe, question, and investigate.
- Maintain accurate and complete student records as required by laws or administrative policies.
- Conduct classes, workshops, and demonstrations to teach principles, techniques, or methods in subjects such as basic English language skills, life skills, and workforce entry skills.
- Prepare10-15 students for further education by encouraging them to explore learning opportunities and to persevere with challenging tasks.
- Provide information, guidance, and preparation for the General Equivalency Diploma (GED) examination for 3-5 students per week.
- Prepare and administer written, oral, and performance tests, and issue grades in accordance with performance.
- Use computers, audio-visual aids, and other equipment and materials to supplement presentations.
- Enforce administration policies and rules governing students.
PREPARATION SPECIALIST
PITTSBURGH JOB CORPS CENTER
Pittsburgh, Pa
01.2005 - 01.2007
- Counsel individuals on a one-on-one basis to help them understand and overcome personal, social, or behavioral problems affecting their educational or vocational situations.
- Maintain accurate and complete student records as required by laws, district policies, and administrative regulations on average of 25-40 records per week.
- Prepare students for later educational experiences by encouraging them to explore learning opportunities and to persevere with challenging tasks.
- Provide students with information on such topics as college degree programs and admission requirements, financial aid opportunities, trade and technical schools, and apprenticeship programs.
- Teach classes of 25-30 students and present self-help or information sessions on subjects related to education and career planning.
- Plan and conduct orientation programs two times per week and group conferences to promote the adjustment of individuals to new life experiences such as starting college.
- Instruct individuals in career development techniques such as job search and application strategies, resume writing, and interview skills.
- Compile and study occupational, educational, and economic information to assist counselees in determining and carrying out vocational and educational objectives.
Education
B.S. Bachelor of Science - Elementary Education
Edinboro University of Pennsylvania
Skills
- Claims investigations
- Confidential records management
- Document retrieval surveys
- Presentation skills
- Evaluation of liability exposure
- Group facilitation
Affiliations
Diversity and Inclusion Curriculum Team Volunteer
PA Life and Health Insurance License, 7/2021
Work Preference
Work Type
Full TimeLocation Preference
RemoteHybridImportant To Me
Company CultureCareer advancementFlexible work hoursWork-life balanceWork from home optionPaid time offHealthcare benefitsPersonal development programsPaid sick leave401k matchStock Options / Equity / Profit SharingQuote
"Get busy living or get busy dying"
Andy Dufresne, Shawshank Redemption
Timeline
Sr. Commercial Claims Examiner
UPMC Health Plan
09.2016 - 06.2024
SENIOR CUSTOMER
SERVICE REP, ALLEGHENY HEALTH NETWORK
03.2015 - 07.2016
SENIOR CUSTOMER ADVOCATE
VERIZON WIRELESS
04.2007 - 05.2014
GED INSTRUCTOR, FORBES ROAD CTC
03.2006 - 04.2007
PREPARATION SPECIALIST
PITTSBURGH JOB CORPS CENTER
01.2005 - 01.2007
B.S. Bachelor of Science - Elementary Education
Edinboro University of Pennsylvania