Jessie Smith
Toledo,OH
Summary
Experienced healthcare support specialist with a background in digital health, benefits navigation, and high-volume remote support. Skilled in resolving member inquiries, coordinating care, and streamlining administrative workflows with empathy, clarity, and strong attention to detail.
Overview
4
4
years of professional experience
Work History
Member Service Associate
Maven Clinic
10.2024 - Current
- Engaged with members via phone, live chat, and messaging to support fertility-benefits inquiries and general service questions.
- Responded to and resolved member questions about fertility managed services, benefits navigation, and insurance coverage in a timely, empathetic, and satisfaction-oriented manner.
- Guided members through insurance reimbursement and payments by assisting with documentation submission, processing receipt claims, and handling issues related to the “Maven Wallet” benefit.
- Triaged Wallet-related support tickets, ensuring efficient workflow, fast member response times, and proper escalation when needed.
- Collaborated with internal teams (operations, finance, member services) to maintain up-to-date member-facing materials, program overviews, and resource documentation
Member Support Specialist
Brightline
04.2024 - 09.2024
- Scheduled therapy and coaching appointments for members across multiple time zones
- Ensured completion and accuracy of all required member paperwork and documentation
- Supported Providers with a wide range of administrative and operational tasks
- Responded to member inquiries and questions between clinical sessions
Billing Coordinator
Tia
08.2023 - 04.2024
- Answered telephone and in person inquiries with friendly demeanor and full knowledge of billing department processes.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Analyzed Explanation of Benefits forms to verify correct billing of insurance
- Worked with payers and healthcare professionals to resolve claim denials
- Knowledge of multiple public and private payers and how to navigate their portals.
- Became a SME on internal billing processes
Determinations Adjudicator
Zion HealthShare
07.2021 - 04.2023
- Reviewed and interpreted medical records to determine sharing eligibility based on membership guidelines.
- Collaborated and communicated with medical providers to establish eligibility.
- Read and understood billing codes to assist with determinations
- Assisted members with concerns regarding their healthcare needs and answered member questions about determinations and healthcare outcomes.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
- Safeguarded member protected health information and followed HIPAA regulations.
- Researched treatment efficacy to determine eligibility.
Education
Bachelor of Science - Social Work
Western New Mexico University
Silver City, NM12.2026
Skills
- Experienced in customer service
- Proficient in Microsoft Office
- Proficient with Google Workspace
- Experience with Salesforce
- Excellent communication skills
- Proficient with Zendesk
- Great understanding of healthcare ecosystem
- Great time management
- Great leadership and organizational skills
- Medical Records Management
- Familiarity with Billing Codes
Timeline
Member Service Associate
Maven Clinic
10.2024 - Current
Member Support Specialist
Brightline
04.2024 - 09.2024
Billing Coordinator
Tia
08.2023 - 04.2024
Determinations Adjudicator
Zion HealthShare
07.2021 - 04.2023
Bachelor of Science - Social Work
Western New Mexico University