Jesse Rawls
Newburg,WV
Summary
Dedicated Insurance Claims Specialist with strong skills in claims investigation, analysis, and policy interpretation. Committed to enhancing customer satisfaction and team performance through mentorship and collaboration.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Insurance Claims Specialist
WVU Medicine
Morgantown, WV
07.2016 - Current
- Evaluated and processed insurance claims to ensure accuracy and compliance with company policies.
- Collaborated with medical providers to gather necessary documentation for claim resolution.
- Conducted thorough investigations of complex claims, identifying discrepancies and fraud indicators.
- Mentored junior staff on claims processing procedures and best practices for efficiency.
- Analyzed trends in claims data to identify areas for process improvement and risk management.
- Followed up with customers on unresolved issues.
- Developed and conducted training sessions for new hires on best practices in claims processing, elevating team performance.
Call Center Representative
WVU Medicine
Morgantown, WV
10.2015 - 07.2016
- Managed high volume of inbound calls, addressing patient inquiries and concerns efficiently.
- Facilitated appointment scheduling using electronic health record systems to optimize patient flow.
- Collaborated with healthcare teams to resolve patient issues, ensuring timely communication of critical information.
- Implemented process improvements that enhanced call handling efficiency and reduced wait times for patients.
- Trained new representatives on call center protocols and customer service best practices to ensure consistency in service delivery.
- Managed high call volumes while providing exceptional customer support and maintaining professional composure.
- Handled escalated calls professionally, effectively resolving complex issues and ensuring client satisfaction at all times.
- Mastered multiple software systems for seamless navigation during calls, improving efficiency and reducing hold times for customers.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries in a timely manner.
Education
Bachelor of Science - Interdisciplinary Studies
West Virginia University
Morgantown, WV05-2013
Skills
- Claims investigation
- Claims analysis
- Policy interpretation
- Teamwork and collaboration
Certification
CRCR - Certified Revenue Cycle Representative
Timeline
Insurance Claims Specialist
WVU Medicine
07.2016 - Current
Call Center Representative
WVU Medicine
10.2015 - 07.2016
Bachelor of Science - Interdisciplinary Studies
West Virginia University