Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nikki Smith

Wilmington,DE

Summary

Claim Benefit Specialist with a proven track record at CVS Pharmacy, excelling in claims analysis and process improvements that enhanced accuracy and reduced processing times. Adept at teamwork and problem-solving, I effectively trained new staff and implemented strategies that optimized operational efficiency. Proficient in HRP and Microsoft Office.

Overview

10
10
years of professional experience

Work History

Claim Benefit Specialist

CVS Pharmacy
02.2023 - Current
  • Reviewed and processed claims to ensure compliance with company policies and regulations.
  • Analyzed claim data to identify discrepancies and resolve issues efficiently.
  • Verify patient eligibility and benefits coverage.
  • Implemented process improvements that reduced claim processing times and increased accuracy.
  • Work in mainframe such as SCM, Rate API, Service Code Detail, and EPDB.
  • Process claims using HRP
  • Working Independently as well as working well in group settings.
  • Trained new team members on claims procedures and best practices for operational effectiveness.

Merchandise Associate

TJ Max
07.2020 - 01.2022
  • Managed inventory levels, ensuring timely restocking and accurate product availability.
  • Collaborated with team members to optimize merchandise displays for increased customer engagement.
  • Trained new associates on store policies, procedures, and effective merchandising techniques.
  • Analyzed sales trends to identify opportunities for promotional strategies and improved product placement.
  • Implemented efficient inventory management practices, reducing discrepancies and improving stock accuracy.
  • Greeted, serviced, and thanked all customers.
  • Utilized strong communication skills to work effectively with team members and resolve customer concerns promptly.
  • Updated pricing and signage to complete product displays and educate customers.

Program Coordinator

Devereux
04.2017 - 03.2020
  • Coordinated program logistics, while ensuring seamless execution of events and activities.
  • Developed training materials, enhancing staff knowledge and operational efficiency.
  • Assisted in budget tracking, ensuring adherence to financial guidelines and resource allocation.
  • Conducted program evaluations, identifying areas for improvement and implementing necessary adjustments.
  • Facilitated meetings and documenting action items to ensure accountability.
  • Mentored junior staff members, promoting professional development and enhancing team performance.
  • Improved staff efficiency by introducing new project management tools and training.

Direct Support Professional

Devereux
07.2015 - 03.2017
  • Provided individualized support to clients, enhancing daily living skills and promoting independence.
  • Assisted in developing personalized care plans, ensuring alignment with client goals and needs.
  • Monitored client progress, documenting behavioral changes and reporting to interdisciplinary teams.
  • Facilitated recreational activities, fostering social interaction and engagement among clients.

Education

Political Science

Lincoln University
1570 Baltimore Pike, Lincoln University, PA 19352
05-2015

Skills

  • Claims analysis
  • Microsoft office
  • Claim investigation
  • Confidentiality handling
  • HRP
  • SCM
  • Excel
  • Teamwork
  • Problem-solving
  • Attention to detail
  • Team collaboration
  • Adaptability and flexibility
  • Claims adjustment

Timeline

Claim Benefit Specialist

CVS Pharmacy
02.2023 - Current

Merchandise Associate

TJ Max
07.2020 - 01.2022

Program Coordinator

Devereux
04.2017 - 03.2020

Direct Support Professional

Devereux
07.2015 - 03.2017

Political Science

Lincoln University

Similar Profiles

CREATE PROFILE
Nikki Smith