Senior Recovery / Resolutions Representative Resume Sample
Molly Herman
380 Eda Trace,
Detroit,
MI
+1 (555) 945 9001
Work Experience
Senior Recovery / Resolutions Representative
12/2016
-
PRESENT
Phoenix, AZ
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract
- Makes fact - based decisions; uses sound judgment and applies business knowledge
- Updates eligibility system / database with outcome of primacy investigation
- Makes fact-based decisions; uses sound judgment and applies business knowledge
- Provide claims expertise support by reviewing, researching, investigating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Fundamental Execution: Plan, prioritize, organize and complete work to meet established production goals, quotas and deadlines in a fast-paced and ever-changing environment
- Fundamental Execution: Plan, prioritize, organize and complete work to meet established production goals, quotas and deadlines in a fast-pace and ever-changing environment
- Provide claims expertise support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Analyze, identify trends and provide reports as necessary
Senior Recovery Resolutions Representative
04/2014
-
07/2016
Boston, MA
- Fundamental Execution: Plan, prioritize, organize and complete work to meet established production goals, quotas and deadlines in a fast pace and ever-changing environment
- Perform Claim adjustments as well as first pass claims processing
- Review member claim history on the UNET Platform
- Determine claims that require medical records for review
- Prepare cases to move to clinical teams
- Ensure compliance with Health Insurance Portability and Accountability Act (HIPAA)
- Review claims platforms, research, and analyze treatment to determine claims relatedness (50%)
- Validate contact information and accident - related injuries (10%)
Education
American Sentinel University
2008 - 2013
Bachelor's Degree in Business
Professional Skills
- Experience using MS Excel for sorting, summing, creating bar graphs, formulas
- Experience using Microsoft Excel (i.e. sorting, summing, creating bar graphs, formulas)
- Experience using Microsoft Excel for sorting, summing, creating bar graphs, formulas
- Experience with Microsoft Excel (i.e. sorting, summing, creating bar graphs, formulas)
- Healthcare experience (i.e. working in an insurance setting, in a provider’s office, billing office, doctor’s office, etc.)
- Experience working with computers and Windows PC applications; maneuvering through multiple windows and typing
- Experience with Microsoft Excel including general data entry, sorting, and modifying spreadsheets
How to write Senior Recovery / Resolutions Representative Resume
Senior Recovery / Resolutions Representative role is responsible for government, travel, insurance, research, database, training, basic, health, windows, etiquette.
To write great resume for senior recovery / resolutions representative job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Senior Recovery / Resolutions Representative Resume
The section contact information is important in your senior recovery / resolutions 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
- Telephone number
Work Experience in Your Senior Recovery / Resolutions Representative Resume
The section work experience is an essential part of your senior recovery / resolutions 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 senior recovery / resolutions 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 senior recovery / resolutions representative position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Senior Recovery / Resolutions Representative resume experience can include:
- Any experience with US Healthcare and / or COB experience
- Outbound call center experience with analyzing and solving customer problems
- Experience with intermediate level of proficiency with Microsoft Excel (data entry, sorting, and filtering)
- Customer service experience; i.e. analyzing and solving customer problems
- Experience in medical insurance; i.e. dealing with insurance from a billing and/or health plan standpoint
- Experience with Microsoft Excel (sorting, and summing)
Education on a Senior Recovery / Resolutions Representative Resume
Make sure to make education a priority on your senior recovery / resolutions representative resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your senior recovery / resolutions 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 Senior Recovery / Resolutions Representative Resume
When listing skills on your senior recovery / resolutions 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 senior recovery / resolutions representative skills:
- Team player; works effectively with others
- Work well in a fast - paced production environment; performing multiple tasks effectively and concurrently
- Health care experience; i.e. working in an insurance setting, in a provider’s office, billing office, doctor’s office, etc
- Working experience with processing C&S, M&R or E&I refunds
- Experience working with MS Word (document creation), MS Excel (data entry), and MS Outlook (sending emails)
- Experience in a role using basic math and thinking analytically and strategically
List of Typical Experience For a Senior Recovery / Resolutions Representative Resume
1
Experience For Senior Recovery Resolutions Representative Resume
- Research and gather appropriate plan documents from multiple sources (15%)
- Prepare Subrogation demand packages for submission to insurance carriers (25%)
- Provide claims support by reviewing, researching, investigating and resolving all types of claims as well as resolution for health plans, commercial customers, and government entities
- Collaborate with others to identify and solve moderate problems that promote efficiency and quality
- Initiate telephone calls to members, providers and other insurance companies to gather COB data
- Update eligibility system / database with outcome of primacy investigation
2
Experience For Senior Recovery / Resolutions Representative Resume
- Meet productivity, quality and timeliness goals
- Respond to routine or standard requests to meet customer needs
- Make fact - based decisions, use sound judgment and apply business knowledge
- Experience with computer and Windows PC applications, including basic knowledge of Microsoft Excel (formulas and navigation), Microsoft Word (creating documents and navigation), and Microsoft Outlook (creating and opening emails)
List of Typical Skills For a Senior Recovery / Resolutions Representative Resume
1
Skills For Senior Recovery Resolutions Representative Resume
- Experience working in the healthcare industry
- Experience using claims platforms such as UNET, COSMOS, NICE, Facets, Diamond, etc
- Intermediate level of experience with MS Excel using the sort and filter functions
- Claims or collections experience within a healthcare setting
- Claims Processing experience on the UNET Platform
- Experience with computer and Windows PC applications, including the ability to learn new and complex systems
- Experience with Microsoft Excel (data entry and creating spreadsheets)
2
Skills For Senior Recovery / Resolutions Representative Resume
- Experience in COMET Processing
- Experience working in Claims Recovery and Resolution
- Experience working in the Healthcare Industry
- Revenue cycle or hospital billing experience
- Understanding of math and thinking analytically and strategically
- Working Hours - business hours - 40 hours standard, OT if business needs dictate but not regular (Start as early as 7am-9am and then 4-6pm end time)
- Knowledge of PC and Windows application including Excel (i.e. sorting, summing, creating bar graphs, formulas)
- Intermediate proficiency or higher with Microsoft Excel - Sorting, summing, creating bar graphs, and formulas
- Intermediate level of proficiency with Microsoft Excel (sorting, summing, creating bar graphs, formulas)
3
Skills For Senior Recovery Resolutions Representative Resume
- Intermediate level of proficiency with Microsoft Excel (sorting, summing, creating bar graphs, formulas etc)
- Knowledge of medical terminology, claims billing / coding, and / or subrogation principles
- Business office environment with moderate noise level due to Representatives talking on computers, printers, and floor activity
- Travel, 2 week training program held in Tennessee and then up to 25% of the time
- Travel, 2 week training program held in Tennessee and then up to 25% of the time (generally local, but some overnight) required
- Open to change and new information; ability to adapt behavior and work methods to changing organization
- Receive and respond to incoming telephone inquiries
- Determine primacy using published COB guidelines
4
Skills For Senior Recovery / Resolutions Representative Resume
- Document and communicate outcome of investigation following departmental procedures
- Business office environment with moderate noise level due to Representatives
- Solve mathematical equations and think analytically and strategically
- Proficiency with PC and Windows which includes the ability to learn new systems quickly
- Experience working with Microsoft Word (document creation), Excel (basic spreadsheet, sorting, and data entry), PowerPoint (basic presentation creation), and Outlook (sending emails)
- Travel, 25% of time. Mandatory 2 week training in Franklin, TN (near Nashville, TN) + 1 week virtual training (from home) + 2 week onsite training
- Intermediate level of proficiency with Microsoft Excel (sorting, summing, creating bar graphs, and formulas)
- Travel to a 2 week training program held in Tennessee and then up to 25% of the time (generally local, but some overnight)
- 10 key data entry proficiency
5
Skills For Senior Recovery Resolutions Representative Resume
- Copy, paste, and format cells within MS Excel
- Experience with MS Excel including data entry, sorting, creating/modifying spreadsheets, creating bar graphs, formulas. Word – the ability to create/edit documents. Outlook – can manage inbox, calendar, and task list
- Intermediate level of proficiency with MS Excel required (i.e. sorting, summing, creating bar graphs, formulas)
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activit
- Travel, up to 25% of the time required (generally local)
- Work between the hours of 6AM - 5PM, EST 8 hours per day for a 40 hour work week
- Travel up to 25% of the time (generally local, but some overnight) required
- Experience working with Microsoft Word (document creation), Microsoft Excel (basic spreadsheet, sorting, and data entry), Microsoft PowerPoint (basic presentation creation), and Microsoft Outlook (sending emails)
6
Skills For Senior Recovery / Resolutions Representative Resume
- ODAR experience
- IDARs experience
- Previous claims or collections experience
- Customer service experience in a health care and / or call center environment
- Self - drive and complete tasks within the given time frames
7
Skills For Senior Recovery Resolutions Representative Resume
- Proficiency with PC and Windows
- Work 40 hours (standard) and overtime if business needs dictate but not regular
- Intermediate proficiency or higher with PC and Windows - Ability to navigate between computer programs and screens
- Solve complex mathematical equations and think analytically and strategically
- Intermediate proficiency with a PC and Windows
8
Skills For Senior Recovery / Resolutions Representative Resume
- Travel, up to 25% of the time (generally local, but some overnight)
- Experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
- Experience in claims recovery and resolution or an operations based role
- Experience in account management / customer service
- Experience in applications EDSS, IDRS and HOST ORS
9
Skills For Senior Recovery Resolutions Representative Resume
- Experience with complex adjustments on UNET Platform
- Experience with ISET Platform
- Claims or collections experience within the healthcare or related industry (Health, Life, Auto, Commercial etc.)
- Intermediate proficiency with PC and Windows applications
- High proficiency with computer and Windows PC applications (ability to create, edit, copy, send and save documents, correspondence, and spreadsheets in MS Word and Excel)
- Focus on Customers, exceed expectations and improve customer experience
- Act ethically, demonstrate integrity, comply with all laws, regulations and policies
10
Skills For Senior Recovery / Resolutions Representative Resume
- Intermediate level of proficiency with Microsoft Excel (sorting, creating bar graphs, formulas and summing)
- Basic proficiency in math and thinking analytically and critically
- Travel up to 25% of the time (generally local but some overnight required)
- Intermediate proficiency with PC and Windows (Navigation)
- Demonstrated knowledge of Microsoft Office products including Excel (creating and editing spreadsheets), OneNote (creating and editing), Outlook (creating and reading emails), PowerPoint (creating, editing and viewing presentations), and Word (creating documents and making edits as necessary)
- COSMOS, FACETS, ISET, NICE, UNET Claims Platforms experience
- Claims or Call Center experience
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