Resolution Representative Resume Sample

4.9
7 votes

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Kelsi Gorczany
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Work Experience


Senior Recovery Resolution Representative
11/2017 - PRESENT
New York, NY
  • No other requirements
  • Experience in Medical/Hospital Insurance related collections
  • Proficient in the use of MS Office suite. Intermediate-to-Advanced Excel and Word skills required. PowerPoint helpful
  • Clear, effective and accurate verbal and written communication skills required
  • Conducts self in accordance with Alere's employee manual
  • Makes decisions and authorize work orders up to a set level
  • Resolve aged warranty claims and expedite to close
  • Performs all tasks in accordance to set performance/methods and procedures, quality assurance and compliance guidelines
Customer Resolution Representative
06/2011 - 08/2017
Phoenix, AZ
  • In accordance with established Methods and Procedures. Decisions made at this level impact the overall claims cost and Customer Satisfaction scores
  • Provides consistent service within established benchmarks contributing to achievement of business Client Service Commitments (CSC’s)
  • Employee utilizes strong negotiation skills in all dealings with Service Partners and/or clients
  • Back up to field calls from Tenet’s toll free line on consumer credit profiles answering questions and complaints pertaining to the facility’s soft inquiry, Central Financial Control’s hard inquiry and/or Central Financial Control’s derogatory reporting onto a consumer’s credit profile
  • Investigate and resolve all claims of identity theft and/or theft of services regardless of LOB by working with consumer, consumer’s representative (i.e. attorney), facility, credit reporting agencies (CRAs), and/or police/sheriff’s department
  • Demonstrates a proficient understanding and use of basic policy/contract coverages and be able to recognize questionable coverage/contract situations which necessitate supervisory involvement
  • Investigation and resolution of disputes ensuring compliance with all applicable federal and state laws and regulations, as well as compliance to all Tenet policies, procedures, and reporting requirements. Types of disputes to be investigated and resolved, include, but are not limited to claims of
  • Drives inquiries from customers and clients towards resolution which includes the identification of the appropriate source of payment or assistance program
  • Records and maintains complete and accurate documentation of all activity performed on appropriate medium
No Fault Customer Claims Resolution Representative
01/2007 - 04/2011
Phoenix, AZ
  • Inappropriate/incomplete insurance billing
  • Fair Collection Practices Act (FCRA)
  • Emergency Medical Treatment and Active Labor Act (EMTALA)
  • Quality of care (including, inappropriate/inadequate diagnosis/care, questionable services, or services not received)
  • Spousal parental liability
  • Proposed accord and satisfaction or restrictive endorsement/conditional payment
  • Provide expertise and guidance to credit reps based on directive provided by the supervisor or manager 30%
  • Keep projects on track for timely delivery 20%
  • Triage customer service and client account related requests and escalate them as appropriate 20%

Education


Strayer University - Fredericksburg Campus
2003 - 2007
Bachelor's Degree in Business

Professional Skills


  • Home Warranty or real estate experience desirable Strong problem solving and conflict resolution skills
  • Sound time-management skills/ability to prioritize quickly and effectively
  • Prior claims handling, liability and damage negotiation experience required
  • Strong passion to delivering top notch Client Experience
  • Typically has 4-6 year’s Customer Service experience in a call center environment with 1-2 years of Lead experience
  • Effectively communicate with insurance carriers Ability to demonstrate knowledge of CMS guidelines Ability to interpret medical EOB's
  • Previous experience in handling customer complaints

How to write Resolution Representative Resume

Resolution Representative role is responsible for insurance, credit, securities, reporting, training, warranty, collections, estimating, compliance, administration.
To write great resume for resolution representative job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Resolution Representative Resume

The section contact information is important in your resolution representative resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Resolution Representative Resume

The section work experience is an essential part of your resolution representative resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous resolution representative responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular resolution representative position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Resolution Representative resume experience can include:

  • Strong commitment to development and high performance
  • Proven ability to take initiative and resolve issues
  • Proven ability to drive quality/process improvements
  • Typically has 4- 6 year’s Customer Service experience in a call center environment
  • Typically has 2-4 year’s Customer Service experience in a call center environment
  • Experience with negotiations and problem resolution

Education on a Resolution Representative Resume

Make sure to make education a priority on your resolution representative resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your resolution representative experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Resolution Representative Resume

When listing skills on your resolution representative resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical resolution representative skills:

  • Strong understanding of Home Warranty polices and technical expertise with systems and appliances
  • Demonstrated problem solving capabilities- ability to analyze data and make recommendations
  • Good working knowledge of Microsoft Office, Lotus Notes,
  • Strong understanding of Home warranty polices and technical expertise with appliances
  • Experience within a Client Service Operations setting
  • Good working knowledge of Microsoft Office, Outlook, and Lotus Notes

List of Typical Skills For a Resolution Representative Resume

1

Skills For Senior Recovery Resolution Representative Resume

  • Typically has 4-6 year’s Customer Service experience in a call center environment
  • Working knowledge of Unitrax and AWD/iFast systems is an asset
  • Extremely organized with the ability to multi-task while maintaining service quality and meeting customer expectations
  • Assist with training and development of new hires and subsequent training needs 5%
  • Assist with training and development of new hires and subsequent training needs
  • Able to decipher customer meaning. (what customer really wants when they complain)
2

Skills For Customer Resolution Representative Resume

  • Work on a computer and utilize telephone systems as required
  • Use and create simple spreadsheets to track their workload, update inventory data at our business partners, and report status upon request
  • Update an online Web based database (Salesforce), that is used to track customer defects and swap out actions
  • Work independently and as part of large team
  • Anticipate what the customer wants accomplished
3

Skills For Account Resolution Representative Resume

  • Knowledge of Mutual Fund and Segregated Fund products and administration
  • Apply judgment and business knowledge to current situations
  • High energy with bias for action and results
  • Operations or Canadian Securities Course (license) is an asset
  • In a Hospital Patient Financial Services department
  • Report the flow of day-to-day operations and the impact of daily challenges for supervisor review 10%
  • Reimburses insured’s deductible where appropriate
4

Skills For Senior Recovery / Resolution Representative Resume

  • Coordinates and pays moderately complex subrogation cases under limited team manager supervision
  • Evaluates auto damage subrogation demands and determines appropriate liability payment
  • Negotiates settlements with 3rd party carriers and/or claimants
  • Processes liability payments and vendor expense payments within established authority
  • Provide expertise and guidance to credit reps based on directive provided by the supervisor or manager
  • Keep projects on track for timely delivery
5

Skills For No Fault Customer Claims Resolution Representative Resume

  • Triage customer service and client account related requests and escalate them as appropriate
  • Report the flow of day-to-day operations and the impact of daily challenges for supervisor review
  • Review and approve all adjustment forms including deferrals. The Account Resolution Team Specialist processes deferrals for the Collections Team to help reduce delinquency thoughout the month
  • Support Contact Center by maintaining all past due accounts in the Collections work flow tool by monitoring the delinquency of the account and ensuring the accounts are in the correct workstate
  • Monitor and action NIGOs via phone, email or fax, as assigned through the Automatic Work Distributor(AWD) system
  • Reimburses insureds’ deductible where appropriate
  • Takes personal accountability

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