Kristin Jacobs
Kissimmee,FL
Summary
Highly motivated and detail-oriented insurance operations professional with 3+ years of experience in claims processing, auditing, and quality. Known for my strong dedication to accuracy and efficiency, with a proven track record of ensuring correct claims workflows. These skills allow me to manage claims processing and resolve complex issues with precision. My passion for improving processes drives me to seek opportunities for career growth.
Overview
7
7
years of professional experience
Work History
Insurance Operations Processor - SME
Oscar Health Insurance
12.2021 - Current
- Subject matter expert in INN Pricing workflows, including pricing methodologies, Oscar Edits, Vendor Edits, etc.
- Utilizing data to review claims adjudication through tools such as Cortex, BigQuery, Faxblast, Periscope, Jira, and Google Sheets.
- Contribute to team goals to improve processes and integrate additional functions into daily operations, such as auditing SLA tickets, identifying documentation gaps, and reviewing claims processors resolutions to provide feedback to Team Lead for coaching.
- Conduct audit reviews for claim adjudication errors, including contract configuration, post pricing edits, and inaccurate denials.
- Participate in projects for the Provider Success team for auditing large sets of data, such as claims processing and adjudication, root cause analysis, Oscar reports, etc.
- Participate in GEMBA sessions with partners and vendors to identify trending claims issues, such as contract configuration errors, Oscar Edits denials, and tooling issues to implement a proper workflow or process improvement.
- Facilitate team meetings with Google Slides to present workflow and process improvement updates to maintain claims quality and SLA turnaround times.
Executive Resolution Specialist - Small Business
Wells Fargo Executive Office
05.2020 - 12.2021
- Facilitated the research and resolution of complaints from Wholesale (B2B) customers.
- Served as a liaison between the customer and the line of business, including legal department, regulatory, payment services, lending, finance, and others.
- Managed end-to-end claims processing for consumer transactions disputes, including fraudulent charges, Zelle payments, and duplicate charges.
- Handled intake requests, ensuring all issues are acknowledged and routed to the appropriate team for resolution.
Protection Agreement Resolution Specialist
Sears Holdings Corporation
03.2019 - 04.2020
- Responded to and followed up on inbound customer calls, written correspondence, and emails regarding SHC product protection plans, including requests to cancel agreements.
- Analyzed the customer's concern/inquiry to determine and execute effective and satisfactory resolution based on the agreement terms and conditions.
- Escalated customer issues when necessary based on established guidelines.
- Responded to escalated concerns/inquiries received by senior management to negotiate a satisfactory resolution for SHC and the customer.
- Initiated follow-up communication with customers to ensure complete resolution.
Training Advocate
Sears Holdings Corporation
11.2018 - 03.2019
- Conducted timely and effective coaching of assigned new hires and incumbent agents.
- Managed calls to provide guidance on proper management of customer situations, including service experiences with technicians, or scheduling maintenance.
- Facilitated group meetings with designated agents to coach areas requiring retraining.
- Conducted side by side coaching during live calls, to assist and guide new hires with any knowledge gaps and supervisor escalation calls with members.
- Ran reports and reviewed performance metrics to identify areas of opportunity, such as call handling time, one call resolution, and cold/warm transfers utilizing appropriate call etiquette.
Protection Agreement Benefits Advisor
Sears Holdings Corporation
08.2018 - 11.2018
- Responded and followed up to inbound customer calls.
- Analyzed the customer's concern/inquiry to determine and execute effective and satisfactory resolution per the agreement terms and conditions.
- Escalated customer issues as needed based on established guidelines.
- Utilized multiple applications/formats enabling access to customer information and entering updates.
Education
High School Diploma -
Gateway High School
05-2012
Skills
- Analysis and Decision Making
- 2 years of proficient experience in Jira
- Strong knowledge of Insurance Operations
- Strong ability to audit claims to identify errors, and maintain quality
- Strong quantitative and analytical skills when reviewing claims data and adjudication
- Proficient in Google Docs Editors suite (eg, Google Docs, Google Sheets, Google Slides)
Timeline
Insurance Operations Processor - SME
Oscar Health Insurance
12.2021 - Current
Executive Resolution Specialist - Small Business
Wells Fargo Executive Office
05.2020 - 12.2021
Protection Agreement Resolution Specialist
Sears Holdings Corporation
03.2019 - 04.2020
Training Advocate
Sears Holdings Corporation
11.2018 - 03.2019
Protection Agreement Benefits Advisor
Sears Holdings Corporation
08.2018 - 11.2018
High School Diploma -
Gateway High School
Similar Profiles
Marcella MirelesMarcella Mireles
Workforce Management Coordinator at Oscar Health InsuranceWorkforce Management Coordinator at Oscar Health Insurance
Ashleigh EmerickAshleigh Emerick
Sr. Director Marketing at Oscar Health InsuranceSr. Director Marketing at Oscar Health Insurance
DAVID PERKINSDAVID PERKINS
Project Specialist at Oscar Health InsuranceProject Specialist at Oscar Health Insurance
Michelle DeanMichelle Dean
Operations Team Leader at Oscar Health InsuranceOperations Team Leader at Oscar Health Insurance
Nicol GuerreroNicol Guerrero
Housekeeping Supervisor at Four Season ResortHousekeeping Supervisor at Four Season Resort