Customer Service and Operations Specialist

NADINE RICHARDSON

**** ******* *****, ******, **, 27713· 914-***-****

********@*****.***

OBJECTIVE: To contribute strong interpersonal and organizational skills in a role focused on customer service and operational excellence.

EXPERIENCE

09/2014 – 08/2024

CONTRACT ASSISTANT, UNITEDHEALTHCARE

REMOTE

• Worked with database management and word processing.

• Handled live calls, took messages, or transferred calls to appropriate individuals.

• Set up and managed paper or electronic filing systems.

• Maintained documents, such as attendance records and correspondence.

• Operated office equipment, such as fax machines/copiers.

• Arranged for repairs when equipment malfunctioned.

• Reviewed insurance policy to determine coverage.

• Input, reviewed, and processed ESI authorization in the system.

• Processed 100+ case events and prior authorizations in the EZ-Cap system daily.

• Handled Humana daily pend report requests.

• Checked benefit in Availity to determine eligibility on member policy.

• Assisted provider services with updated details on member policy/procedures.

• Distributed denial letters to providers' offices.

• Handled incoming incidents from previous cases that have issues.

• Provided training to new hires for the pain management department.

• Reviewed and prepared insurance claim forms or related documents.

• Transmitted claims for payment or further investigation.

• Contacted insured or other involved persons to obtain missing information. 2

03/2006 – 02/2014

CLAIMS MANAGER / TRAINER, DIRECTBUY OF WESTCHESTER ELMSFORD, NY

• Handled the performance reviews and personal records for all employees.

• Managed payroll and employee time records.

• Performed database management and word processing tasks.

• Managed paper or electronic filing systems and recorded information.

• Operated office equipment, such as fax machines, copiers, or phone systems.

• Arranged for repairs when equipment malfunctioned.

• Managed front desk inquiries and visitor assistance.

• Maintained scheduling and event calendars.

• Scheduled and confirmed appointments for clients, customers, and supervisors.

• Provided order placement services and account information to customers.

• Reviewed and edited work for accuracy and company compliance.

• Established work procedures for clerical staff.

• Delivered software training and technical support on all company software. EDUCATION

BACHELOR OF BUSINESS ADMINISTRATION,

MONROE COLLEGE, NEW ROCHELLE, NY

ASSOCIATE OF COMPUTER SCIENCE,

MONROE COLLEGE, NEW ROCHELLE, NY

SKILLS

• Ability to provide claim advice.

• Proficient in MS-Office Suite and internet

applications.

• Experienced in insurance-related

activities and terminologies with an

exceptional interest in marketing.

• Ability to manage various claim projects

and provide detailed information to

clients, members, and providers.

Contact this candidate