Resolution Specialist Resume Samples

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Resolution Specialists provide assistance to a company’s customers to ensure a high level of satisfaction. Essential work duties seen on a Resolution Specialist resume sample are taking incoming phone calls in a call center, maintaining client interaction records, solving problems efficiently, connecting customers with available resources, and adhering to company guidelines. A well-written example resume for this role will focus on skills like customer service, conflict resolution, patience, good listening and communication skills, and computer literacy. Most Resolution Specialists have some college education and receive on-the-job training.

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1

Claims Resolution Specialist

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
Candidate Info
13
years in
workforce
3
months
at this job
Nursing
2

Bodily Injury Claims Resolution Specialist II

  • 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.
Candidate Info
11
years in
workforce
2
years
at this job
BA
Environmental Studies / Political Science
Communications
3

Bodily Injury Claims Resolution Specialist

  • 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
Candidate Info
7
years in
workforce
8
months
at this job
BS
Business Information Systems
4

Property Resolution Specialist

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.
Candidate Info
6
years in
workforce
2
years
at this job
5

Senior Account Supervisor/service Resolution Specialist II, Executive Office

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
Candidate Info
22
years in
workforce
4
years
at this job
BA
Science
BA
Bachelor of Arts
6

Dispute Resolution Specialist

  • 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.
Candidate Info
12
years in
workforce
3
years
at this job
BA
Interior Design
MS
Human Resources Generalist
7

Customer Resolution Specialist I

  • 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.
Candidate Info
6
years in
workforce
3
years
at this job
BA
Women And Gender Studies
8

Account Resolution Specialist

  • 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, )
Candidate Info
5
years in
workforce
4
months
at this job
HS
High School Diploma
9

Client Resolution Specialist

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
Candidate Info
6
years in
workforce
2
years
at this job
BBA
Finance
10

Resolution Specialist

  • 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.
Candidate Info
17
years in
workforce
10
years
at this job
BA
Business Management

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