Olivia Snipes
Jacksonville,FL
Summary
Detail-oriented professional with 8 years of experience in claims processing and customer service, seeking a Claims Examiner role. Proven expertise in claims management systems, compliance regulations, and resolving discrepancies with high accuracy. Skilled in data analysis, problem-solving, and effective communication, with a strong background in insurance verification and policy knowledge.
Overview
9
9
years of professional experience
Work History
Claims Processor
Teleperformance
03.2023 - Current
- Process medical and healthcare claims in alignment with policy guidelines and compliance regulations.
- Review claims for accuracy, eligibility, and coverage determination.
- Investigate discrepancies and coordinate with providers and members to resolve issues.
- Maintain detailed documentation within claims management systems.
- Meet daily production targets while ensuring high accuracy standards.
- Escalate complex claims for supervisor review when necessary.
Customer Service Representative
TD Bank
02.2022 - 02.2023
- Managed high-volume customer inquiries via phone and email, consistently meeting quality and productivity benchmarks.
- Utilized CRM and banking systems to efficiently resolve account issues and process transactions with accuracy.
- Ensured compliance with internal policies and adhered to data security regulations.
- Documented customer interactions in case management systems to support auditing and reporting efforts.
- Collaborated with cross-functional teams in a virtual environment to efficiently resolve escalated issues.
Patient Success Representative
Humana
08.2019 - 12.2021
- Managed inbound and outbound patient communications for medical supply resupply and account management.
- Verified insurance coverage and accurately processed patient orders.
- Navigated multiple software systems concurrently while upholding call quality standards.
- Ensured compliance with HIPAA regulations to protect patient health information.
- Documented patient interactions in CRM and order management systems.
- Resolved billing discrepancies and coordinated with providers and insurance carriers.
Customer Service Resolution Specialist
Convergys
Jacksonville, FL
06.2017 - 06.2019
- Managed high-volume inbound calls, resolving billing, delivery, refund, and account-related concerns effectively.
- Investigated escalated customer issues using CRM systems and internal databases for efficient resolution.
- Performed root cause analysis to identify service breakdowns and implemented corrective actions.
- Documented detailed case notes, ensuring compliance with company standards.
- Met key performance indicators including Average Handle Time, First Call Resolution, Customer Satisfaction, and Quality Assurance metrics.
- Collaborated with internal departments to resolve cross-functional issues.
- Identified customer trends and provided feedback to improve operational processes.
Education
Bachelor of Business Administration - undefined
Florida State College at Jacksonville
Skills
- Analytical Skills
- Attention to Detail
- Communication Skills
- Problem-Solving
- Decision-Making
- Negotiation Skills
- Knowledge of Insurance Policies
- Time Management
- Customer Service
- Data Entry Proficiency
- Claims Processing & Resolution
- Contact Center Operations
- CRM Tools & Software Navigation
- Case Management Systems
- HIPAA & Compliance Awareness
- Data Analysis & Trend Identification
- Root Cause Analysis
- Salesforce
- Zendesk
- ServiceNow
- Workday
- Microsoft Excel
- Outlook
- Google Workspace
- Call Center Dialer Systems
- Avaya
- Genesys
- Five9
- Knowledge Base Systems
- Microsoft Teams
- Insurance Verification
- Case Management
- Epic
- Meditech
- Kareo
- NextGen
- FIS Profile
- Trizetto
- SharePoint
- DocuWare
- QNXT
- Xifin
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Claims Processor
Teleperformance
03.2023 - Current
Customer Service Representative
TD Bank
02.2022 - 02.2023
Patient Success Representative
Humana
08.2019 - 12.2021
Customer Service Resolution Specialist
Convergys
06.2017 - 06.2019
Bachelor of Business Administration - undefined
Florida State College at Jacksonville