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Jessica
Customer Service Representative
Contacto
Competencias
Demonstrated experience with Customer support by phone, email, and live chat.
Demonstrated experience with Order processing, refunds, and returns.
Demonstrated experience with Account troubleshooting and issue resolution.
Demonstrated experience with Customer and vendor record keeping.
Demonstrated experience with Medical claims processing and adjudication.
Resumen
Customer Service Representative open to new opportunities
Experiencia
Customer Service Representative
Answered inbound phone calls, emails, and live chats from buyers and sellers on a high-volume marketplace platform.. Listened to customer concerns and provided clear, accurate information about products, orders, and site policies.. Troubleshot technical issues with customer accounts and digital carts, escalating unresolved cases as needed.. Processed product orders, refunds, exchanges, and return requests.. Updated customer and vendor profiles in the database with accurate, detailed notes.. Resolved account issues and handled inquiries end to end, maintaining a professional and service-focused approach.
Claims Examiner
Analyzed and processed medical claims in accordance with plan provisions and regulatory requirements.. Verified the accuracy of submitted information, including patient details, treatment dates, and billing codes.. Conducted thorough investigations into claims to identify discrepancies or potential fraud.. Gathered additional information and documentation as needed to support claim determinations.. Assessed medical records, physician notes, and other healthcare documents to determine the necessity and appropriateness of claimed services.. Interpreted and applied medical terminology and coding standards throughout the claims process.. Corresponded with healthcare providers, policyholders, and other relevant parties to obtain information and clarify details.. Provided status updates and explanations of claim decisions to stakeholders.
Claims Specialist
Analyzed, investigated, and processed medical claims, verifying patient details, treatment dates, and billing codes for accuracy.. Reviewed medical records and physician notes to determine the necessity and appropriateness of claimed services, applying medical terminology and coding standards.. Corresponded with providers, policyholders, and internal partners to obtain documentation and resolve discrepancies.