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Resolution Specialist Resume Samples
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0-5 years of experience
Researched and resolved outstanding claim payment issues for claims previously adjudicated or in pending status.
- Reviewed incorrectly adjudicated claims and determined appropriate payment of claims within contractually agreed time frames
- Performed proper adjustment for incorrectly adjudicated claims adhering to all polices, processing refunds, voids, grievances, over and under payments, provider referrals, COB referrals, reinsurance splits, and other necessary adjustments
- Exceeded required production target by 66% and achieved 100% of financial quality
- Entered claims into Med/Mc Claims processing system as needed.
- Adjudicated and processed escalated provider projects assigned by leadership in a timely manner
- Resolved special inquiries from management or various departments in a timely and accurate fashion
- Provided ongoing communication with leadership regarding trends and or special projects
- Maintained quality and quantity levels specified by immediate supervisor
- Assisted team lead in training and developed new team members on a needed basis
- Adjudicated special claim types such as MSI and OB. with high accuracy and within timely standards
0-5 years of experience
- Managed, investigated and resolved injury claims while providing service to policyholders and customers.
- Investigated facts of loss by gathering recorded statements, completing detailed scene diagrams, reviewing property damage photographs and analyzing other available evidence to determine proper liability.
- Evaluated complex coverage questions through study and investigation of policy language.
- Identified potential suspicious claims for referral to special investigations and recognized opportunities for subrogation.
- Coordinated inspection of property damages and repairs through referral to auxiliary resources as necessary to ensure complete customer satisfaction.
- Effectively utilized loss management techniques to negotiate settlements with attorneys, claimants and co-defendants.
0-5 years of experience
- Negotiated settlements with attorneys, claimants, and/or co-defendants
- Managed, investigated, and resolved injury claims.
- Provided excellent customer service by communicating effectively with policyholders, witnesses, attorneys and claimants in order to gather information regarding claims and advise proper course of action
- Responded timely and effectively to various written and telephone inquiries including status reports
- Ensured adequacy of reserves
0-5 years of experience
The Property Resolution team was responsible for the handling of short sales, deed-in-lieu, short pays, and full payoffs.
- Evaluated potential risks and kept open communication regarding these risks with many different management levels.
- Managed a large portfolio and consistently met communication goals.
- Worked with investors to negotiate high property value sales.
- Consistently took on new processes and quickly adapted to new rules/regulations.
0-5 years of experience
Acting as a liaison between customers and company’s Executive Team, handling variety customer issues during various stages of sale and post-sale cycle, and responsible for resolving issues escalated up the corporate chain (including CEO).
- Rapidly promoted on merit to the Resolution Specialist after seven months in customer service
- Answer customer escalation calls from other CSRs and ensure their concerns addressed
- Handle creation and updates of various reports used by HSN leadership team.
- Manage logistics reports used by UPS and other shipping companies used by HSN
- Work closely with customer service representatives, ensuring the customer resolution is timely and within HSN corporate guidelines.
- Team Leader for Connect Team tasked with team engagement and training
- Won Vision Award of 2016 – a quarterly company-wide award in “Our Integrity is Non-Negotiable” category. Demonstrates integrity, respect, and doing the right thing.
- Assisted customers in CSR capacity with various inquiries regarding their purchases and account questions, assuring the calls result in “win-win” situation for all stakeholders.
- Ranked in the top 5% of performance base twice with company of over seven-thousand
0-5 years of experience
- Work in a Human Resources centric environment adhering to guidelines pertaining to discretion, confidentiality and compliance.
- Created job shadowing program expansion from legal and compliance only to additional departments to aid in employee engagement, and retention.
- Utilized various methods of communication in order to effectively and efficiently interact with both internal and external candidates.
- Interviewed, developed and trained new hires as well as aiding in the creation of four new SOP’s for consolidated processes.
- Closed out 100% backlogged cases 8 weeks ahead of schedule, thereby aiding in risk mitigation by reducing the amount of clients who would have sought outside counsel.
- Primary contact of the department to resolve critical cases on time without further escalation.
- Engage with candidates to ascertain their core concerns, provided investigation and resolution.
- Created detailed metrics for quantifying work that was completed by lower level associates.
- Facilitated cross departmental collaboration with various leaders to resolve inquiries, legal filings, student account adjustments and to assist with internal and external audits of the institution’s departments.
0-5 years of experience
- Conducted thorough research and analysis of customer inquiries and appeals using departmental guidelines, compliance information and customer insurance plan to make informed and accurate determinations.
- Applied strict regulatory compliance and state-mandated appeal response deadlines to resolve inquiry and appeal cases.
- Prepared customer appeal cases for our corporate grievance panel, maintaining high quality standards throughout the process.
- Developed well-written and thorough correspondence to customers to include state regulatory language and citations in response to inquiry and grievance appeal requests.
- Worked cross-functionally with the legal, compliance and claims departments to ensure all inquiry and appeal cases were accurately and effectively resolved.
- Completed Insurance education classes, which included Individual Medical, Small Group, as well as Medicare curriculum.
- Provided mentoring to new hires and newly transferred co-workers, which included on the job training, one-on-one training, and answering questions via email, instant message, and telephone.
0-5 years of experience
- Made record of complete and accurate documentation of all activity performed on client accounts.
- Assisted with resolution on outstanding medical accounts.
- Maintained exceptional service and integrity with customers and client accounts through accurate, timely, relevant, and quality work efforts
- Obtained member eligibility
- Understands medical terminology, EOBs, insurance follow-up processes
- (Billing, Collections, Managed Care, Medicare, Medicaid and Commercial Practices, CPT4 codes, ICD10 codes, UB04, HCFA, )
0-5 years of experience
Manipulate data from three online source systems using complex excel formulas to create daily reports used to verify client
account information and update cost basis as necessary for over 50 client accounts
- Reconcile client’s capital markets position and proceeds information daily for accurate 1099 tax reporting
- Analyze numerous account breaks and errors and determine course of action for resolution
- Completed an online, company-sponsored 5 course specialization in Investment Management with the University of Geneva
6-10 years of experience
- Developed unique solutions to merchandising problems.
- Researched and resolved vendor problems using Retail Link.
- Coordinated buyers, vendors, and clients on special orders to ensure accurate and timely delivery.
0-5 years of experience
Established trust with existing clients, assisted with day-to-day use of platform and investment products
- Facilitated smooth training for new users/clients
- Point of contact between clients and tech teams
- Handled customer complaints and inquiries through client relations lines
- Assisted branch representatives and financial advisors with client inquiries and account maintenance
- Trained new hires
0-5 years of experience
- Exceeds satisfaction for all customers through effective and timely resolution of a variety of inquires; GRE 3.16 or higher/CRT 225 or less
- Build customer loyalty and rapport with effective resolution; OPA
- Uses resources and training tools wisely in order to balance the needs of the business and the customer; knowledge of Microsoft, Outlook
- Meet and exceed company standards for productivity and quality
- Complete required trainings regularly on company policies; able to work flexible schedule, positive team player
0-5 years of experience
Proactively audit and review high revenue generating channels on a quarterly basis for operational and process improvements
- Responsible for overseeing performance of assigned portfolio, resolving escalated issues as needed.
- Maintains files on all past due accounts, documenting details of methods utilized to secure payment.
- Ensured compliance of all state and local collection procedures
- Perform Skip Tracing in order to achieve contact communication with clients to reach account resolution.
- Responsible for the collection of warranty accounts in a call center environment
- Collect in compliance with the provisions of the FDCPA, FCRA, and internal performance standards to achieve budget.
0-5 years of experience
- Responsible for using strong customer service skills to efficiently assist consumers who have been victims of identity theft.
- Placed 90 day fraud alerts with all three credit bureaus so that creditors are requested to contact consumers before approving applications.
- Actively searched for information on possible imminent data breaches and shared that information with my team.
0-5 years of experience
- Heavy outbound calling and speaking with individuals
- Wrote accurate account notes to record all collection activities performed
- Educated consumers about repayment options and negotiating repayment arrangements
- Performed necessary follow-up activities and is available for incoming phone calls
- Performed all duties in compliance with Company’s core values, policies and procedures, clients’ standards, and federal and state laws
- Maintained positive attitude, a high level of ethics, and professionalism
0-5 years of experience
- Research outstanding Medicaid and commercial insurance balances for hospital group.
- Contact insurance plans for clarification of denials or resolution of discrepancies to resolve accounts.
- Update information in AS/400 system and excel spreadsheet.
- Discovered method to submit electronic medical records saving time and paper. Taught method to team.
- Repeatedly selected by Director of office to take on new roles and be part of new project for a client.
0-5 years of experience
- Completed daily escalation tasks and reports for misapplied payments review, customer account complaints, and loss mitigation reversals
- Took escalated manager calls, assisted agents daily in the chat queue
- Trained and conducted classes for the new onboard Trainees and upskills
6-10 years of experience
Work closely with internal departments and account management team to provide service recovery and conflict resolution for members who have had negative business relations with [company name].
- Resolve corporate breakdowns; take issues affecting our business as a whole and provide solutions to satisfy all parties involved.
- Serve as Assist Line for Call Center, 500+ employees.
- Assist local pharmacists in the adjudication of insurance claims as well as enter real time overrides to allow claims to pay when appropriate.
- Maintain customer records, authorize customer credits as well as authorized returns of goods-through our mail order pharmacies.
- Work with Training Department to facilitate learning for colleagues on a monthly basis.
0-5 years of experience
- Maintain friendly and professional customer service interactions
- Address customer service inquiries in a timely and accurate manner for an average of forty inbound calls daily
- Negotiate with customers to arrange a payment plan that will bring account to current in a timely manner
- Maintain accurate documentation on all accounts during each interaction
- Understand and apply all policy changes for excellent customer service experiences for each customer
10+ years of experience
- Receive, review, and resolve an average of 150-200 auto claims per month
- Issue payments to customers in accordance to policy specifications
- Currently exceeding company customer service NPS goal. Goal 75% current score 93%
- Collaborate with team to ensure company quality standards are met
0-5 years of experience
- Negotiating payments while continuing to build a positive rapport with customers.
- Utilize skip tracing resources to locate up to date information for consumers.
- Assisted in staff meeting their collection goals.
- Trained new employees by mentoring and providing assistance when needed.
- Achieved monthly collection goals.
10+ years of experience
- Case manages and coordinates member grievances
- Ensures day-to-day implementation of the grievance and process and adheres to Federal and State Regulation’s, Medicare, Department of Managed Healthcare and the Plan’s policies and procedures.
- Assists in identifying opportunities to improve the quality of care and service delivered to plan members.
- Advocates for plan members, and promotes satisfaction and retention.
0-5 years of experience
- First contact resolution providing support for both stores and customers
- Effectively managed a high-volume of inbound calls
- Accurately documented, researched and resolved customer service issues.
- Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment.
- Defused volatile customer situations calmly and courteously.
- Mastery of customer service management systems and databases.
- Referred unresolved customer issues to designated subject matter experts for further investigation.
0-5 years of experience
- Reviewed and analyzed all available documents and records in order to draft and present a Plan of Action to the client.
- Corresponded with service providers with the goal of negotiating fair settlement values based on merits of each case.
- Updated clients via regularly via reports or phone conversations to discuss the status, issues and goals of each case.
- Communicated with the DIR, WCAB, insurance companies and parties’ attorneys in order to expedite case closure.
- Maintained an inventory of an average of 80 files among five clients.
- Assisted with private investigators and insurance companies special investigation units in order to unify data needed to litigate cases.
- Assisted in the development and testing of a proprietary database which automated identification of potential fraudulent
- Continually studied pending cases, appeals, case law, labor code and Business and Professional code in an effort to stay on the cutting edge of claims analysis and litigation.
0-5 years of experience
- Maintains exceptional service and integrity with customers and client accounts through accurate, timely, relevant, and quality work efforts of all inventory assigned to the self-pay billing revenue cycle and call center.
- Resolves account inquiries from customers and clients.
- Informs management of operational issues impeding performance or customer satisfaction including but not limited to those impacting the customer, client, or the company.
- Constantly meets regulatory compliance call standards.
- Selected to participate in Focus Group to maintain employee engagement.
- Participates in the Conifer Ambassador Program to promote fundraising and volunteer work.
0-5 years of experience
Independently investigate, negotiate and manage bodily injury and property liability claims with or without attorney representation. Complete all needed referrals and documentation for litigated files, including initial review of the complaint, strategy discussions with defense council and attend meditations for settlement.
- Lead CCR review training
- Received award for mentor of the quarter
- Created and led property training for 3rd party liability claims
- Assist the department with 3rd party liability estimate reviews
- Assist the department with 3rd party liability negotiations
- Maintain all adjuster licenses
- Created and led Fire inspection training for Property field Personnel
0-5 years of experience
- Locate and notify borrowers of defaulted student loans primarily through mail, telephone, or skip tracing methods in order to resolve their obligations with the US Department of Education.
- Verified accuracy of data with loan servicers and Department of Education resources.
- Recorded and updated account activity including but not limited to borrowers financial status, demographics, and collection efforts associated with resolving the account.
- Adhered to the FDCPA, Privacy Act and all federal and state laws governing the 3rd party collection industry.
- Handle all borrow concerns and disputes. Provide exceptional customer service
0-5 years of experience
- Manages an average of 96 commercial claims and 600 workers compensation/liability medical accounts per month to ensure prompt payment and minimal cycle time
- Reviews 1500 and UB claims to ensure coding is accurate and streamline cycle time
- Corrected negative charges and late charges billed
- Organizes requested documents for lawyer’s offices
- Handles refiling and consistent follow up with insurance companies and/or adjusters
- Retrieves required forms such as authorization or codes from doctor’s offices, clinics and departments
0-5 years of experience
Researching, resolving and collecting on all assigned accounts and performs a variety of medical billing and collection duties.
- Follow-up (phone, e-mail, regular mail) with insurance companies/patients regarding claim/payment status through our practice management system and reporting tools.
- Communicate with consumers by telephone and approved written correspondence to attempt to bring resolution to unpaid accounts.
- Make necessary adjustments to patient demographic, insurance, and account balance information.
- Adhere to all regulatory compliance areas, policies and procedures (including HIPAA and PCI compliance requirements), and “leading practices”.
0-5 years of experience
for the Pennsylvania Patient Assistance Program
- Contact Patients enrolled in the program, review file and medications.
- Research medications for manufacturers programs, that may offer medications at little or no cost to the Patient.
- Complete letters on the computer, for patients and Doctors with instructions to accompany the completed Manufacturers applications.
- Assist the Patient thru the applications process as well as filling out PACE and Low-income subsidy applications on line when needed.
- Update and enter Patient data collected into the data base
- Completing notes on computer data base to reflect interaction with the Patient for future reference
0-5 years of experience
Responsible for successfully collecting on accounts from brokers or debtors’ that is past due, while reflecting good productivity, appropriated timeliness, and low error rates. Duties included:
- Work with client, debtor, and booking agent to resolve problems such as missing paperwork, missing check/ACH payments, or any deductions not specified on paperwork.
- Conduct collection calls on accounts from brokers or debtors that are past due
- Updating client’s information
- Identify “red flags” or risks clients during various processes
0-5 years of experience
- Support consumers over the phone to identify and implement viable payment solutions
- Schedule and assign orders to appropriate contractors to ensure expectations are met and information provided is understood
- Utilize the internet skip tools provided and the phone to locate customers and/or collateral and recover for client
- Coach team regarding effective skip tracing techniques, acts as subject matter expert and troubleshooter
- Assist with the management of skip tracing activities to include but not limited to identifying individual performance opportunities, process improvement and training
- Responsible for ensuring compliance with applicable laws, regulations and company policies across the areas of organizational responsibility
0-5 years of experience
- Call center environment handling service requests and customer enquiries, researching account information with homeowners and contractors
- Obtain reports from contractors and approved authorization work orders up to $300
- Purchase necessary parts and equipment
- Take ownership of claim and aged claims to drive closure and resolve in a timely manner
- Respond to emails and voicemails from customers
- Dispatch claims to contractors to meet service guidelines
0-5 years of experience
- Resolved delinquent student loan accounts.
- Accessed multiple screens.
- Documented client information correctly and efficiently.
- Executed 100 to 400 calls per day.
- Received account payments over the phone.
0-5 years of experience
- Oversee 50+ licensed Benefit Counselors as a resource, subject matter expert, mentor and coach to strengthen their product knowledge and system skills.
- Collaborate with business partners to resolve complex issues and determine root causes involving benefits and payroll matters.
- Primary point of contact for client’s HR department to address and solve escalated issues.
- Review recorded calls upon request of client or Service Delivery Team to assess and report findings due to complaints or appeals.
- Assist Talent Acquisition Team interviewing and hiring new applicants for employment.
- Create and present product training power points for continual education of benefit counselors.
0-5 years of experience
- Compares and evaluates possible customer service solutions, and decides which to recommend to customers to best meet their needs and circumstances.
- Responsible for prompt and accurate response to Reverse Mortgage servicing questions and concerns.
- Input data and verify information as it pertains to processing telephone draft payments.
- Adhere to operational controls, including legal, corporate, and regulatory procedures to ensure the safety and security of customer mortgage assets.
0-5 years of experience
- Assist Resolutions Department heads with clerical support.
- Compute, record, and proofread data information in the databases.
- Update and continuously maintain multiple databases workflow.
- Use basic office machines such as: copy machine, fax machine and printer.
- Distribute internal communications and emails effectively to appropriate personnel.
0-5 years of experience
- Utilize a wide variety of computer based software programs, applications and job related databases
- Conducts detailed research and identifies causes and provides solutions.
- Documents associate concerns and provide feedbacks; communicates data trends across departments.
- Completes assignments and priorities by using policies, data, and resources; collaborates with managers, co-workers and business partners.
- Determining and recommending ways to improve opportunities and 1st customer resolution for store associates
0-5 years of experience
- Develops and leverages relationships with peers, supervisor and management.
- Uses professional concepts and company policies and procedures to solve a wide range of difficult problems.
- Provides direction in overseeing company’s internal investigation of complaints and serves as liaison
- Identifies overlaps and related processes.
- May assist in the development of project plans
0-5 years of experience
- Answer incoming phone calls from providers and identify the type of assistance the provider needs (e.g. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
- Review member’s medical information such as prescriptions for verification and updating purposes
- Meet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance
- Deliver all information in a positive and upbeat tone
- Assisting peers when needed Experience
0-5 years of experience
- Handle inbound and outbound member, provider and physician calls.
- Answer questions related to pharmacy benefits, while maintaining productivity standards and performance guarantees where applicable
- Work with other operational departments to research and resolve mail order and claims issues and respond to members within performance agreement guidelines
- Maintain accurate and complete documentation of all inquiries in order to continuously improve the customer service process and reduce potential legal concerns
- Identify and escalate in a prudent manner, concerns received from patients and/or clients so that corrective action can be pursued and expedited to take care of their needs
- Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety guidelines
- Other duties as needed
0-5 years of experience
- Assist borrowers with student loans to get out of federal default.
- Enroll students into the loan rehabilitation program.
- Monitor accounts on payment plans to prevent default.
- Collet on defaulted student loans
- 100-200 outbound calls daily
- Skip- Tracing to contact and locate borrowers
0-5 years of experience
- Provide customer service and address store issues
- Develop and streamline processes and procedures
- Analyze emails and phone calls to provide store resolution in areas of concern
- Make sure agents have the most up to date information available to them for a fast one contact resolution
- Make sure our buying team is aware of issues as soon as they arise for a quick fix
0-5 years of experience
- Contact borrowers via phone to negotiate payment in full or best qualifying program
- Skip-trace, 3rd party probing to locate and notify borrowers of delinquent student loans
- Attain all Key Performance Indicators and meet monthly performance goals determined
- Adhere to U.S Department of Education’s standards and all [company name] guidelines and policies
- Keeping production and meeting monthly goals while maintaining superior Customer Service
0-5 years of experience
- Assess each account and take the appropriate actions necessary to obtain complete adjudication of the patients claim
- Assist patients and their insurance carriers to resolve open account balances
- Review an average of 75+ claims per day
- Audit claim from other representatives to ensure all efforts have been exhausted in recovery
0-5 years of experience
- Handle customer auto claims by resolving the most complex claims
- Settle claims while following company policy and procedure
- Obtain information and maintains accurate records about accidents from customers and claimant via phone and written reports.
- Arrange and reschedule appraisals, review appraisal reports, communicate with customers, claimants, witnesses, attorneys, 3rd party carriers and repair shops, etc. Secure title or other documentation required to sell vehicles for salvage
0-5 years of experience
- Manages, investigates, and resolves claims. Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels.
- Makes effective use of loss management techniques. Negotiates settlements with attorneys, claimants, and/or codefendants.
- Communicate with interested parties in order to gather information, refer tasks to auxiliary resources as necessary, and advise as to proper course of action.
- Accountable for security of loss financial processing of claims, as well as security information contained in 140+ claims files.
0-5 years of experience
- Service high risk and high value accounts.
- Performed in an auto dialer environment working in preview and predictive mode
- Responsible for identifying early and late stages of collections
- Worked manual unverified cell phone queue with objective of adhering to fair practice and lending laws.
- Utilized negotiate skills to resolve delinquency
- Responsible for preventing net credit loss to the bank.
- Process client payments and evaluate for hardship arrangements.
0-5 years of experience
- Communicate with consumers by telephone and approved written correspondence to attempt to bring resolution to unpaid accounts
- Counsel Delinquent consumers to assist in finding funds to meet their payment obligations
- Demonstrate effective, skip tracing techniques by locating consumer contact information
- Educate Bankruptcy consumers on how they can bring their account current with out trying to collect on the property
- Provide thorough, efficient, and accurate account updates on computer files for each inbound call made or received
- Work with the customer on loan modification documents.
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Resolution Specialist
Last edited by: Gabriela Barcenas, CONTENT STRATEGIST -
Gabriela Barcenas
CONTENT STRATEGISTGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
