Center Agent Call
Resume:
NICOLE ANGEL NIEVES
*********************@*****.***
(PLEASE EMAIL)
NICOLE ANGEL NIEVES
(FACEBOOK AND INSTAGRAM)
SUMMARY OF QUALIFICATIONS
A dedicated and bilingual
(Spanish and English)
Customer Service-Administrative Professional with strong attention to detail and proficient at prioritizing and completing tasks in timely manner; flexible and able to multitask when necessary.
SKILLS
MS Office Suite
Telemarketing
Call Center
Training
Medical Case Research
VOLUNTEER EXPERIENCE OR LEADERSHIP
Call Center and Marketing Manager
Volunteer for Food Share and Yard Goats
EXPERIENCE
CARECENTRIX
UTILIZATION MANAGEMENT- CARE COORDINATOR
2016-2020
Verification for following health plans:
Horizons, Coventry, Fallon, PEIA, NHP, Florida Blue & Cigna
Processing of denial and approval letters and for multiple services the following home care services such as:
PAP therapies, CPAPS, home infusion & and/or other home care services
Elevations to Medical Director, so that able to able to process decisions for approvals and/ or denials
Sending Correspondence to both patients and medical providers via letters to both patients and medical providers
Ensured that notification TAT was always met in a timely manner thru both oral or written in timely matter communication for Florida Blue and Horizon patients
Work with Management on Special projects to ensure that authorizations letters were triggered again in timely manner and received to all parties which both including patients, rendering & attending providers as well
Communication between Nurses, Letter team & CAT team
Reviewing daily reports via Excel to ensure correction are made letters made in timely matter when & if needed
NETWORK SERVICE ASSOCIATE/ CALL CENTER AGENT
2016 – 2017
Provided Tier 2: Research cases through SharePoint/ PowerPoint
Received 150 calls daily and made an outbound of 50 calls to providers
Both Patients and Providers were given resolution in timely matter
Assisted Management when needed and performed duties as gatekeeper for two separate offices in Harford and Florida
Worded internally via Outlook and chats
Managed a team of over 20 people
EDUCATION
1997 – 2001 - High Honors
Warren Harding High School
Fox Institute of Business Now Known as American Institute
Legal Office Profession
Certification 2005
O.I. C
Customer Service
Certification 2003
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