Summary
Overview
Work History
Education
Skills
Timeline
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Jessica Talton

Monroe,LA

Summary

Proven Member Service Auditor with a track record of enhancing audit efficiency and customer satisfaction at Louisiana Health Service Indemnity Company. Excelled in compliance standards and critical thinking, achieving streamlined processes and improved client relations. Demonstrated expertise in Microsoft Excel and effective communication, leading to significant audit process improvements and positive client feedback. Also experience Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering over 10 years of experience and willingness to take on any challenge.

Overview

9
9
years of professional experience

Work History

Member Service Auditor

Louisiana Health Service Imdemnity Company
01.2023 - Current

Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.

  • Maintained confidentiality, handling sensitive information discreetly throughout all stages of audit process.
  • Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
  • Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
  • Planned and executed follow-up audits at appropriate intervals.
  • Developed strong relationships with clients, building trust and ensuring high level of satisfaction during audit process.
  • Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within our team.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
  • Answered constant flow of customer calls with minimal wait times.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Updated account information to maintain customer records.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
  • Researched and analyzed complex claims to determine next steps and possible outcomes.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Followed up with customers on unresolved issues.
  • Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
  • Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
  • Developed strong relationships with clients, facilitating trust and open communication during claims process.
  • Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.

Member Service Auditor

Vantage Health Plan, Inc.
06.2017 - 12.2022
  • Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
  • Maintained confidentiality, handling sensitive information discreetly throughout all stages of audit process.
  • Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
  • Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
  • Planned and executed follow-up audits at appropriate intervals.
  • Developed strong relationships with clients, building trust and ensuring high level of satisfaction during audit process.
  • Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within the team.
  • Increased internal control effectiveness through diligent evaluation of processes and providing recommendations for improvement.
  • Performed observations and evaluated supporting documents to supplement audit findings.
  • Conducted risk assessments to determine areas requiring increased focus during subsequent audits.
  • Coordinated, managed and implemented auditing projects and prepared for evaluation.
  • Managed multiple concurrent audit engagements, prioritizing tasks to meet deadlines without compromising quality.
  • Adapted plans and schedules to meet changing priorities of work objectives, resources and workload demands.
  • Interpreted state and federal laws, accepted auditing principles and procedures and program standards to audited materials and data to detect non-compliance and facilitate recommendations.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Enhanced claims processing efficiency by streamlining workflows and implementing best practices.
  • Streamlined claims processing for faster resolutions and improved customer experiences.
  • Resolved complex claims issues for improved client experience and retention rates.
  • Reduced claims processing time by implementing efficient workflow and prioritizing tasks.

Dispatcher

New Wave Communication
09.2015 - 06.2017

managed high-stress situations calmly and effectively, ensuring timely assistance to those in need.

  • Communicated with drivers and personnel to coordinate timely delivery of goods and materials.
  • Directed dispatching, routing, and tracking of [Numbe fleet vehicles.
  • Collaborated with fellow dispatchers to maintain a seamless workflow during shift changes.
  • Maintained accurate records of all dispatched calls, improving data tracking for future analysis.
  • Managed conflict resolutions with customers, drivers and other personnel to encourage professional relationships and promote respect.
  • Provided exceptional customer service to callers, remaining empathetic and patient during emergencies.
  • Promoted teamwork among colleagues by proactively assisting others when needed.
  • Maintained updated and detailed records of calls in physical and electronic database.
  • Trained new dispatchers on company protocols, contributing to a well-prepared team of professionals.

Education

Bachelor of Science - Health Administration

University of Phoenix
Tempe, AZ
01.2022

Skills

  • Problem-solving abilities
  • Computer Proficiency
  • Microsoft Excel
  • Payment Processing
  • Microsoft Outlook
  • Scheduling
  • Professional telephone demeanor
  • Team Development
  • Insurance Claims Review
  • Claims Investigation
  • Time Management
  • Coverage Determination
  • Policy understanding
  • Teamwork and Collaboration
  • Eligibility Determination
  • Insurance Coverage Verification
  • Medical Terminology

Timeline

Member Service Auditor

Louisiana Health Service Imdemnity Company
01.2023 - Current

Member Service Auditor

Vantage Health Plan, Inc.
06.2017 - 12.2022

Dispatcher

New Wave Communication
09.2015 - 06.2017

Bachelor of Science - Health Administration

University of Phoenix
Jessica Talton