Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

Jessica Gaatz

Suamico,WI

Summary

Professional with a history of meeting company goals utilizing consistent and organized practices. Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate systems.


Effective at operating within state and federal regulations and department guidelines to manage telephone calls, emails, letters and requests for assistance.


Overview

16
years of professional experience

Work History

Humana

Dental Claims Processor
01.2013 - 10.2019

Job overview

  • Reviewing incoming member and provider correspondence
  • Request and review x-rays, narratives, and EOB’s
  • Process dental claims
  • Contact member’s and provider’s to obtain dental necessity information
  • Process claims real time with member’s and provider’s on the line.
  • Checked documentation for accuracy and validity on updated systems.
  • Generated, posted and attached information to claim files.
  • Maintained strong knowledge of basic dental terminology to better understand services and procedures.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.

Green Bay East High School

Freshman Softball Coach
02.2017 - 06.2017

Job overview

  • Increased player strength, agility and game skills through successful practices.
  • Promoted proper stretching, warmups and conditioning exercises to prevent sports injuries.
  • Trained athletes in proper use of equipment for safety and maximum results.
  • Developed game plans and adjusted to meet various game situations.

Notre Dame Academy

Assistant JV Softball Coach
02.2016 - 06.2016

Job overview

  • Assisted head coach with instructing players in the rules, regulations, equipment, and techniques of the sport
  • Organized and directed individual and small group practice activities/exercises
  • Assessed player’s skills, monitored players during competition and practice
  • Assisted with determining game strategy
  • Maintained the equipment room in orderly condition
  • Distributed equipment and uniforms to students
  • Participated in special activities to include parent’s night, banquets, and awards night
  • Performed support tasks such as distributing and maintaining eligibility forms, emergency data cards, and other related records
  • Modeled nondiscriminatory practices in all activities.
  • Helped players develop skills such as discipline and observation to further enhance team success.
  • Provided effective physical training and conditioning to meet player position requirements and team needs.
  • Increased player strength, agility and game skills through successful practices.
  • Coached players on successful batting, pitching and catching techniques.

Northeast Wisconsin Technical College

Math Adjunct
01.2011 - 01.2013

Job overview

  • Test students in the areas of Math, Reading, Writing, Social Studies, and Science
  • Use students’ scores to form a learning plan geared toward obtainment of their GED/HSED
  • Work with students to advance their learning plans
  • Monitor progress and refer students for a GED when ready
  • Instruct college math for NWTC Students
  • Prepare lesson plans, tests, and grade students.
  • Evaluated students' progress in attaining educational goals and objectives.
  • Diversified teaching techniques and learning tools help students with differing ability levels and varied learning modalities.

Humana

Claims Review
08.2009 - 01.2013

Job overview

  • Review claims and start investigations for possible material misrepresentation and pre-existing conditions
  • Refer claims to underwriting for investigations based on Health Care Reform Mandates
  • Process claims
  • Request and read medical records
  • Determine and apply pre-existing conditions to members’ plans
  • Answer member questions in regards to investigations.
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Examined claims forms and other records to determine insurance coverage.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Answered customer telephone calls promptly to avoid on-hold wait times.

United Healthcare

Customer Service Representative
03.2007 - 08.2009

Job overview

  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Answered constant flow of customer calls with minimal wait times.
  • Offered advice and assistance to customers, paying attention to special needs or wants.
  • Documented and detailed calls and complaints using call center's CRM database.
  • Adhered to company policies and scripts to consistently achieve call-time and quality standards.
  • Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
  • Verified insurance coverage by telephone to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
  • Scanned, received and sent faxes to insurance claims, co-pay assistance information and patient documentation.

Green Bay Public School District

Substitute Teacher
01.2006 - 07.2006

Job overview

  • Provided quality instruction in the absence of the regular teacher
  • Maintained a classroom climate that enabled all students to master skills appropriate to his or her age, grade level, and individual capacity
  • Helped students develop socially and emotionally.

Education

St. Norbert College

Bachelor of Arts from Elementary/Middle School Education - Math

University Overview

Skills

  • Insurance Claim Forms Review
  • Small Claims Payouts
  • One Call Resolution
  • Issue Resolution
  • Coverage Determination
  • Customer Satisfaction
  • Customer Inquiries
  • Quality Assurance
  • Productivity Standards
  • Medical Records Management
  • Time Management
  • Performance Monitoring and Optimization

Timeline

Freshman Softball Coach
Green Bay East High School
02.2017 - 06.2017
Assistant JV Softball Coach
Notre Dame Academy
02.2016 - 06.2016
Dental Claims Processor
Humana
01.2013 - 10.2019
Math Adjunct
Northeast Wisconsin Technical College
01.2011 - 01.2013
Claims Review
Humana
08.2009 - 01.2013
Customer Service Representative
United Healthcare
03.2007 - 08.2009
Substitute Teacher
Green Bay Public School District
01.2006 - 07.2006
St. Norbert College
Bachelor of Arts from Elementary/Middle School Education - Math
Jessica Gaatz