Open To Work
Felicia Nelson
Cleveland
Summary
Detail-oriented claims processing and customer service specialist with a strong background in Salesforce and Meditrac. Streamlined processes to enhance operational efficiency and resolve conflicts effectively, resulting in improved customer satisfaction. Committed to driving positive business outcomes through effective problem-solving.
Overview
17
17
years of professional experience
Work History
Transportation Specialist
Provide A Ride
Cleveland
11.2025 - Current
- Coordinated transportation schedules for efficient client pickups and drop-offs.
- Managed logistics to ensure timely and safe transport of clients.
- Communicated with clients to address transportation needs and concerns.
Pharmacy Assistant
Regalo Rx
Overland Park
10.2024 - 11.2024
- Answered incoming calls promptly, courteously, and professionally.
- Adhered to all HIPAA regulations regarding patient privacy and confidentiality.
- Utilized pharmacy management software to input patient data and process insurance claims.
Claims Specialist
Liberty Dental Plan
Las Vegas
12.2020 - 10.2024
- Provided technical guidance and training to new staff members regarding claim processing procedures.
- Adhered to all applicable laws, regulations, and company standards while processing claims.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
Claims Assistant
Ajilon Staffing Agency
Las Vegas
12.2019 - 03.2020
- Collected payments, processed receipts and informed policyholders of outstanding balances.
- Monitored electronic claims submissions and bad debt write-offs.
- Analyzed claims data to identify trends and recommend changes to reduce risk and prevent fraud.
Volunteer
Ronald McDonald House
Las Vegas
10.2018 - 02.2020
- Built partnerships with related organizations to develop support and gain greater attention for important issues.
- Assisted with fundraising efforts, including event planning and donor outreach.
- Collaborated with others by contributing time, effort and skills to achieve the organization's goals.
Claims Representative
Progistics Distribution
Las Vegas
10.2018 - 02.2019
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Assisted new policyholders with processing claims.
- Negotiated settlements with claimants and attorneys to resolve claims efficiently and fairly.
Worker’s Compensation Claims Adjuster
CLEVELAND CLINIC FOUNDATION
Cleveland
06.2012 - 10.2018
- Calculated and authorized payment of claims within designated authority level.
- Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.
- Conducted witness interviews to assist claim information gathering process.
Patient Financial Counselor
University Hospitals
Cleveland
06.2013 - 11.2015
- Answered, screened and processed high volume of calls daily with call management system and web-based communications.
- Maintained call logs and records of customer interactions using CRM software.
- Consulted with customers to resolve service and billing issues.
Prior Authorization Coordinator
AreaTemps
Cleveland
08.2009 - 05.2012
- Reviewed and verified financial data, ensuring accurate determination of program eligibility.
- Processed appeals according to policy guidelines.
- Input claims, prior authorization, and essential medical data into system for efficient processing.
Education
Certificate - Business
Whitney M. Young Jr. Job Corps Center
Simpsonville, KYHigh School Diploma -
Collinwood High School
Cleveland, OHSome College (No Degree) - Business Administration
University of Phoenix
Las Vegas, NVSkills
- Transportation Planning
- Logistics Management
- Supply Chain Coordination
- Route Optimization
- Fleet Management
- Logistics Support
- Regulatory Compliance
- Microsoft Proficiency
- Process Improvement
- Problem solving
- Customer Service
- Conflict resolution
- Active listening
- Empathy
References
References and additional employment history available upon request.
Highlightsandskills
- Customer Service Representative
- Processed Dental Claim inquiries for DHMO/PPO/EPO/GOVERNMENT/WC products
- Performed eligibility/benefits verification, documentation of client’s information, HIPPA authentication utilizing Salesforce-CRM, Conduent-Meditrac, Microsoft, Macess tools
- Proficient processing Level I and II grievances and appeals in customer’s escalations and Medicaid/Medicare/Commercial product guidelines
- Audited referral processing/insurance coverage data entry accuracy utilizing Allscripts, AS400 applications
- Processed client pharmacy, medical and worker’s compensation claims in Epic and referral/prior authorization approvals/denials processing for financial clearance in Facets
- Creating helpdesk tickets, troubleshooting, and resolving Level 1 provider/member web portal issues
- Effectively handled angry/frustrated customers by actively listening, showing empathy, using positive and providing solutions to resolve issues without escalating the situation further
Timeline
Transportation Specialist
Provide A Ride
11.2025 - Current
Pharmacy Assistant
Regalo Rx
10.2024 - 11.2024
Claims Specialist
Liberty Dental Plan
12.2020 - 10.2024
Claims Assistant
Ajilon Staffing Agency
12.2019 - 03.2020
Volunteer
Ronald McDonald House
10.2018 - 02.2020
Claims Representative
Progistics Distribution
10.2018 - 02.2019
Patient Financial Counselor
University Hospitals
06.2013 - 11.2015
Worker’s Compensation Claims Adjuster
CLEVELAND CLINIC FOUNDATION
06.2012 - 10.2018
Prior Authorization Coordinator
AreaTemps
08.2009 - 05.2012
Certificate - Business
Whitney M. Young Jr. Job Corps Center
High School Diploma -
Collinwood High School
Some College (No Degree) - Business Administration
University of Phoenix