CLAURESA NILES
HICKORY,US
Summary
Customer Care Associate with extensive expertise in customer service, demonstrated through roles at Sysmex, Signature Performance, and Aetna/CVS. Proficient in SAP, Zendesk, and CPT coding, with a strong focus on enhancing customer satisfaction and loyalty. Committed to leveraging skills in communication and problem-solving to support seamless customer experiences and drive service excellence.
Overview
9
9
years of professional experience
Work History
Benefits Verification Specialist
Caremetx
Chicago, IL (WFH)
11.2025 - Current
- Analyzed patient benefits to ensure accurate eligibility verification.
- Collaborated with healthcare providers to resolve discrepancies in coverage information.
- Streamlined processes for obtaining prior authorization through effective communication with insurance companies.
- Mentored junior team members on best practices for benefits verification procedures.
- Maintained comprehensive knowledge of evolving insurance policies and regulations to ensure compliance.
Customer Experience Representative (Claims)
Safelite Auto Glass
WFH
08.2025 - 10.2025
- Managed customer inquiries, providing accurate information and resolving issues efficiently in the claims process
- Executed follow-up communications to ensure customer satisfaction and foster long-term loyalty.
- Collaborated with cross-functional teams to streamline processes and improve service delivery.
- Promoted upselling opportunities when appropriate, contributing to increased revenue generation through add-on sales or upgrades of existing products services.
Healthcare Concierge
Aetna/CVS
WFH
03.2025 - 08.2025
- Resolved customer inquiries regarding healthcare plans and benefits, ensuring clarity and satisfaction.
- Facilitated communication between members and healthcare providers to streamline service delivery.
- Utilized CRM software to document interactions, enhancing record accuracy and follow-up efficiency.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company''s database.
Customer Experience Representative
Signature Performance
WFH
09.2023 - 03.2024
- Enhanced patient satisfaction through effective communication and problem resolution.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
Customer Service Representative
Joerns Healthcare LLC.
Charlotte, NC
06.2018 - 06.2023
- Resolved customer inquiries and issues through effective communication and problem-solving techniques.
- Managed high-volume calls while maintaining exceptional service standards and customer satisfaction.
- Collaborated with team members to enhance service delivery processes and improve response times
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
Benefits Verification Specialist
Talent Bridge/Lash Group
Fort Mill, SC
10.2016 - 02.2018
- Ensured accurate insurance verification, enhancing patient-provider communication efficiency.
- Resolved coverage issues, improving patient understanding and reducing administrative delays.
- Collaborated with providers, expediting approvals for smoother onboarding and service satisfaction.
- Provided empathetic support to patients facing insurance challenges, fostering trust and contributing to positive healthcare experiences.
- Reviewed complex insurance documentation to identify discrepancies, enabling timely resolution and reducing claim denials for patients.
Education
Associate - undefined
Rowan-Cabarrus Community College
Greensboro, NC05.2026
Skills
- Typing 35-40 wpm (Experienced)
- AP/AR (Skillful)
- AS400 (Experienced)
- OUTLOOK (Expert)
- EXCEL (Skillful)
- WINDOWS (Expert)
- SAP (Expert)
- WORD (Expert)
- Customer Service (Expert)
- CMS 1500 form (Skillful)
- CPT coding (Skillful)
Timeline
Benefits Verification Specialist
Caremetx
11.2025 - Current
Customer Experience Representative (Claims)
Safelite Auto Glass
08.2025 - 10.2025
Healthcare Concierge
Aetna/CVS
03.2025 - 08.2025
Customer Experience Representative
Signature Performance
09.2023 - 03.2024
Customer Service Representative
Joerns Healthcare LLC.
06.2018 - 06.2023
Benefits Verification Specialist
Talent Bridge/Lash Group
10.2016 - 02.2018
Associate - undefined
Rowan-Cabarrus Community College