Client Support Specialist with Healthcare Focus

Victoria Nelson

Belleville, MI ***** 302-***-**** **********@*****.*** www.linkedin.com/in/victoria-nelson-750925192 Summary

Customer support professional with over 10 years of experience in insurance billing, healthcare case processing, and remote client support. Skilled in guiding customers through complex systems via chat and email, maintaining and updating knowledge bases, and managing multiple tasks in fast-paced settings. Known for patient, empathetic communication and effective problem-solving to ensure seamless user experiences. Skills

• Customer Service & Support: Customer Service, Customer Support, Intake Specialist, Call Center, sales and services, Escalations, Communication, Telecommunications

• Technical & Tools: Basic Computer Skills, CRM, Salesforce, SLACK, Microsoft, Microsoft Office, Teams, Fax, Intercom, Google Workspace

• Healthcare & Insurance Expertise: Medicaid, Benefits, HIPAA, CPT Coding, SIG, Medical Office, Prior Authorization, appeals and grievences, Billing Processes, Medical Insurance Terminology, Healthcare Experience

• Soft Skills & Operations: Knowledge Base Development, Disaster Recovery, Time Management, Multi-tasking, Adaptability, Problem Solving, Attention to Detail, Metrics, Team lead

Work Experience

Turningpoint Healthcare Clinicals Operations Representative 2026 - Present Customer service and medical case processing in a remote setting. Processing requests via phone, fax, and email and providing or validating request information. Supporting Utilization Review Nurses in creating medical cases. Maintaining HIPAA confidentiality and ensuring compliance with all policies. Respond to customer questions via phone and written correspondence. Working in clinical operations creating procedure authorizations. Familiarity with CPT codes, diagnosis codes, health plan policies, reconsiderations, resubmissions, retro cases, peer 2 peer, and appeals.

• Provided timely and accurate customer support via phone, fax, and email, utilizing Google Workspace for documentation and case tracking

• Processed medical case requests and supported Utilization Review Nurses by applying medical insurance terminology to validate procedure authorizations

TURBOTAX (Through SITEL, NOW CALLED FOUNDEVER), USAA P&C Insurance Agent Oct 2023 - Jan 2026 Work on property and casualty claims, take insurance payments, membership services, liability, deductible, rental, and repair information.

• Managed property and casualty claims using CRM tools to log interactions, update customer records, and escalate issues as needed John Boner Neighborhood Centers Energy Assistance /Intake Specialist Dec 2021 - Sep 2023 Scanning and processing utility assistance applications. Assisting clients by phone and face to face with intake for housing, career coaching, case management, and submitting rental payments. Non profit organization Anthem, Inc PBM/ Enrollment Sep 2018 - Apr 2021

Medicaid inbound calls from new members, physicians, health and human services. Pharmacy Claims, inquiry of benefits, deadlines, cancellation of benefit for multiple states. SIG, ICD codes.

MedImpact Pharmacy Benefits Management Nov 2016 - Apr 2018 Pharmacy benefits and claims. Assist members, pharmacy, and physician's office with all claims, prior authorizations, billing, benefits, overrides, appeals and grievances. Medicare part d. Interpret SIG, CPT codes and speak with Pharmacist for prescription verification, contact physician’s office for any medical history needed for approval.

Walgreens/Rite Aid Pharmacy Pharmacy Technician Call Center Oct 2013 - Oct 2016 I worked in a Specialty Drug Pharmacy call center. Submit pharmacy calls to customers insurance. Make support order processing and is scheduled for delivery correctly depending on medication type. Assist customers with approved medications under their plan, if they have any deductibles or coinsurance amounts. Complete third-party verification and work with insurers plan rejections. Submit prescription data correctly under HIPPA guidelines.

Imperial Healthcare Centre Office Clerical Receptionist Dec 2010 - Aug 2013 Process patient admissions and discharge forms. Answer multi-phone line, intake and submit employee call offs. Provide daily census reports and residential roster for building. Process all incoming mail using postage machine. Taking all payments; daily cash log, receipt and dropped. Assisting all Physicians, Social Workers, Vendors, and Visitors with hospitality, paperwork and resident information. Texas Health and Human Services Commission Texas Works Advisor II Aug 2009 - Dec 2010 Working with Hurricane Katrina victims receive monetary compensation. Receive estimates from FEMA field workers who total the victim damages and total loss. Approve FEMA granted amounts doubling as an emergency disaster relief specialist. Making sure all loss was reported by field workers and no additions were added by claimant that was not verified by Conduent Team Lead Escalations Feb 2006 - Aug 2009 Worked on three different state contracts Medicaid provider claims and billing, assist physicians and nurses with certification, termination issues with state Medicaid practicing credentials. Medicaid Enrollment and new member support via calls, email, and mail for enrollment, benefits status, and coverage concerns State employees’ workers compensation, process new claims, submitting time sensitive information and troubleshoot any claim errors to get all required documentation in a timely manner SBC/AT&T Specialty Team Member/ Account Services Dec 2000 - Jan 2006 Worked in over four different departments in a specialty call center assisting law enforcement with establishing phone traces. Handled sales, billing, payments and escalations. Also worked with lifeline for fixed income customers, and the win back department establishing service for customers.

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