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Blue Cross Blue Shield of Texas - Claims Quality Coach Resume Example

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Emma Stewart
XXX XXXXX XXXX, Harleton, TX 75651
XXXXXXXXXXXXXXXXXXXX
Ph: XXXXX XXXXXXXX
Professional Summary

Service-oriented professional with 10+ year background in various customer service roles. Core competencies include computer proficiencies (Including but not limited to MS Office applications), focus on results, and organization as well as excellent communication and time management skills. Handles tasks with accuracy and efficiency.

Skills
  • Active Learner & Listener
  • Organized & Efficient
  • Complex Problem Solver
  • Computer Proficiency
  • Service Oriented
  • Teamplayer
Experience
Claims - Quality Coach Mar 2013Present Blue Cross Blue Shield of Texas Marshall, TX
  • Utilize system tool to pull specified number of random claim samples for a set group of Claims Examiners.
  • Track to ensure valid sample sizes are met for each Examiner; subject to quarterly changes.
  • Audit claims for accuracy and compliance with company processes and department procedures.
  • Prepare detailed reports on audit findings including coaching opportunities and financial impact.
  • Schedule and facilitate one-on-one coaching sessions (face-to-face or via web-ex) with Examiners to discuss rebuttal, error impact,  and proper resolution.
  • Keep informed regarding processing changes, trends, and best practices.
  • Voluntarily partner with "at risk" Claims Examiners to observe their daily routine and personal processes to formulate Action Plan to assist them in meeting department quality and production metrics. 
  • Voluntarily serve on recognition committees that recognize employees nominated for outstanding efforts and employee quality achievements Monthly and Yearly.
  • Voluntarily serve on committee to represent BCBSTX in the community utilizing company mascot - Blue Bear.
Claims Examiner Jan 2012Mar 2013 Blue Cross Blue Shield of Texas Marshall, TX
  • Adjudicate various types of claims using the company's claim processing system while maintaining department production and quality metrics.
  • Communicate with Providers and other insurance companies to coordinate benefits and properly investigate claims.
  • Attend weekly huddles, and training sessions to learn new skills and receive technical assistance with ever-changing industry trends.   
  • Recommended and served on Special Project Team to investigate, resolve, and adjudicate complex claims issues.
  • Recommended and served on Memo Committee designed to review current department policies and procedures for frequent updates and efficiencies.
  • Voluntarily served on committee to represent BCBSTX in the community utilizing company mascot - Blue Bear.
Administrative Assistant May 2005Jan 2012 Blue Cross Blue Shield of Texas Marshall, TX
  • Prepare various types of reports, memos, letters, and other documents, using word processing, spreadsheet, database, or presentation software.
  • Answer phone calls and direct calls to appropriate parties or take messages.
  • Maintain and stay proficient with company timekeeping system to report payroll for specified department.
  • Make low-cost travel arrangements for management.
  • Set up and manage paper or electronic filing systems, recording information, updating paperwork, or maintaining documents, such as attendance records, correspondence, or other material.
  • Operate office equipment, such as fax machines, copiers, or phone systems and arrange for repairs when equipment malfunctions.
  • Coordinate and support internal communications and events for the department designed to improve awareness, morale, efficiency, and improvement.
  • Voluntarily served on recognition committee designed to recognize employee outstanding contributions in the department.
  • Voluntarily served on committee designed to promote diversity in the office.
  • Voluntarily served on committee to represent BCBSTX in the community utilizing company mascot - Blue Bear.
Day Program Leader Oct 2003Mar 2005 Breckenridge Village of Tyler Tyler, TX
  • Serve as an advocate to clients:  Helping to provide a safe, fair and loving environment that is like home.
  • Provide information in Annual Reviews, and Service Plans to help parental guardians and other staff members know progress of client's residential placement.
  • Assisting in meeting specified goals by planning purposeful activities for client during day programming.
  • Accompany clients to and from daytime activities (Including Meals on Wheels, East Texas Food Bank, Tyler Recycling Center, Library, and other planned outings).
  • Offer relief assistance for weekly house-parents during the week and on weekends, assisting clients with daily routines.
Education
Bachelor of Arts: Major: Sociology, Minor: Religion May 2003 East Texas Baptist University Marshall, TX
High School Diploma May 1998 Santa Fe High School Santa Fe, TX
Community Service
  • Volunteer, Wonderland of Lights Festival - 2011-2013
  • Volunteer, Mission Marshall - Current
  • Volunteer, Youth Director, Nesbitt Baptist Church - Current
  • Participant, Relay For Life of Harrison County - Current
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Resume Details

This is a real resume for a Claims Quality Coach in Harleton, Texas with experience working for such companies as Blue Cross Blue Shield Of Texas, Breckenridge Village Of Tyler. This is one of the hundreds of Claims Quality Coach resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Quality Coach resume.

Previous Companies:

  • Blue Cross Blue Shield of Texas
  • Breckenridge Village of Tyler

Previous Job Positions:

  • Claims Quality Coach
  • Claims Examiner
  • Administrative Assistant
  • Day Program Leader

Schools:

  • East Texas Baptist University
  • Santa Fe High School

Level of Education:

  • Bachelor of Arts
  • High School Diploma

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