Open To Work
Krissy Cole
Murray,UT
Work Preference
Summary
Claims professional with keen eye for detail and commitment to excellence bringing valuable experience in claims resolution and dispute management.
Known for collaborative teamwork and achieving results am dependable and adaptable to changing needs. Proficient in negotiation, problem-solving, and maintaining regulatory compliance with reputation for reliability and professionalism.
Overview
6
6
years of professional experience
Work History
Claims Resolution Specialist
Castell Health
03.2024 - 07.2025
- Resolved 150+ Medicare claims monthly with high accuracy, reducing processing errors and improving patient satisfaction.
- Automated Excel/VBA tasks, saving the team 5+ hours of manual work weekly.
- Developed and implemented SOPs and process documentation, improving workflow efficiency and team consistency.
- Identified recurring system and data issues and collaborated with IT to implement long-term solutions.
- Facilitated claims processing by analyzing documentation for accuracy and completeness.
- Resolved complex claims issues, ensuring compliance with policies and regulations.
Pharmacy Benefits Specialist
SelectHealth
02.2023 - 03.2024
- Processed 75+ prior authorizations weekly with 100% audit accuracy, ensuring timely access to medications for members.
- Collaborated with providers, pharmacies, and insurance carriers to resolve complex claim discrepancies, reducing delays.
- Educated members on plan limitations, deductibles, and out-of-pocket maximums to improve understanding and engagement.
- Maintained strict HIPAA compliance while managing sensitive patient information.
- Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and online chat interactions.
Individual & Small Employer Sales Rep
SelectHealth
10.2022 - 01.2023
- Managed 90–105 inbound/outbound calls daily, achieving 95% customer satisfaction and 94% enrollment conversion.
- Processed 600+ applications while advising members on plan selection, ensuring accurate and timely enrollments.
- Assisted with account updates, broker transfers, and ID card replacements, reducing administrative errors and improving member experience.
- Analyzed customer feedback to inform product development and improve offerings.
Resident Operations & Sales Specialist
Bungalow LLC
06.2021 - 07.2022
- Led the recovery of critical enrollment workflows during a system outage at month-end, collaborating with IT to restore secure platform access and maintain time-sensitive resident communications.
- Directly enabled 185% overachievement of September enrollment goals, recognized in team meetings for saving month-end performance under pressure.
- Designed and implemented process improvements to prevent recurring workflow disruptions, enhancing operational resilience and member experience.
- Managed high-volume leasing and renewal operations in a fast-paced startup environment, ensuring compliance and timely execution.
- Managed 75–150 tickets daily, achieving 96% conversion and 130% renewal rates; exceeding monthly renewal goals.
- Implemented automation and scripting to streamline ticket resolution, reducing response times.
Retention & Credit Repair Paralegal
Lexington Law
08.2020 - 02.2021
- Resolved complex client issues, ensuring retention and satisfaction.
- Managed case documentation, follow-ups, and communications to support timely resolution.
- Assisted clients in understanding legal processes, improving engagement and outcomes.
Account Management Specialist
Vivint Security
10.2019 - 07.2020
- Handled escalations, billing, and account inquiries using Salesforce CRM, improving customer experience.
- Identified and resolved fraud and eligibility issues for services and equipment.
- Collaborated with internal teams to optimize account management processes and retention.
Education
Sociology
Salt Lake Community College
01.2018
Skills
- Member Advocacy
- Healthcare Payer Portals
- Healthcare Systems
- CRM Navigation
- Salesforce
- Data Entry
- Data Analysis
- Technical Troubleshooting
- HIPAA Compliance
- Workflow Optimization
- Claims Processing
- Google Suite
- Microsoft Office Suite
- Claims Investigation
- Client Relations
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Accomplishments
- Owned the resolution of a critical month-end enrollment system outage, partnering directly with IT to restore secure platform access and re-enable time-sensitive workflows. As a result of this intervention, the team surpassed monthly enrollment goals by 185%, turning a projected shortfall into a record performance. This achievement was recognized in team meetings for its direct impact on operational outcomes under high-pressure, end-of-month conditions.
Certification
- HIPAA Compliance Training - 2022-2025
Timeline
Claims Resolution Specialist
Castell Health
03.2024 - 07.2025
Pharmacy Benefits Specialist
SelectHealth
02.2023 - 03.2024
Individual & Small Employer Sales Rep
SelectHealth
10.2022 - 01.2023
Resident Operations & Sales Specialist
Bungalow LLC
06.2021 - 07.2022
Retention & Credit Repair Paralegal
Lexington Law
08.2020 - 02.2021
Account Management Specialist
Vivint Security
10.2019 - 07.2020
Sociology
Salt Lake Community College