Janesse Nieves

• Collaborated with claims department and industry anti-fraud organizations to resolve claims.
• Reported policy changes and company conditions affecting customer satisfaction.
• Analyzed information gathered by investigations to report findings and recommendations.
• Followed up with customers on unresolved issues.
• Modeled exceptional customer service skills and appropriate diagnostic sales techniques to team members.
• Evaluated accuracy and quality of data entered into agency management system.
• Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
• Made contact with insurance carriers to discuss policies and individual patient benefits.
• Generated, posted and attached information to claim files.
• Prepared insurance claim forms or related documents and reviewed for completeness.
• Reviewed outstanding requests and redirected workloads to complete projects on time.

Support in lead capacity for technical and administrative activities for The Physical Medicine and Rehabilitation and Orthopedic Surgery Registration Department. Assisting the supervisor in providing day-to-day coordination of call center activity. Assisting with training staff and serve as a resource for staff relations to complex situations. Receive inbound contacts (calls, emails, faxes, etc.) from patients and physicians requesting services within JHMI.
Coordinate complex appointment scheduling linking consults, procedures and ancillary services required for specialty and multiple sub-specialties with the department, maintaining patient demographic and insurance pre-registration information in multiple scheduling systems (Meditech, IDX, OCIS, MOSAIQ or EPIC).
Referral tracking and handling of MediCal records. Provide patients with information on physicians, directions to locations and educational materials. Answer patients or physicians questions.
Responsible for satisfying the customer and maintaining the image of JHM.

Maintaining 90% club average in Quality Assurance month- to -month and contributing to quota adherences weekly above 90% on all standardized metrics.

Provide excellent customer service to customers by answering inquiries, finding correct solutions. Responsible for all customer inquiries and questions. Follow up to customer inquiries by taking specific action in a timely manner, gathering as much information and determining the right course of action with Policy Holders. Problem solve to help customers resolve issues on first call implementing critical thinking and reconciliation. Enters data from customers into various software programs. Including but not limited to, Lotus Notes, Omni software. Additional use of EVS. Appropriately communicate with upset customers to resolve their inquiries, maintaining composer and controlling the flow of the call using various communication skills including empathy, balanced-tone of voice and clear explanation of Policy description.Thrives as a team player in a fast-paced, high-energy, change-oriented environment.Exercise retention efforts when appropriate. Time-management of High Call volume was a must. 200 calls a day were monitored by QA. Average 90% month-to-month in quality with minimal errors and crossed trained in MediCal for the State of California

Greet, register, and assign rooms to guests of hotels or motels. Make and confirm reservations. Issue room keys and escort instructions to bellhops. Keep records of room availability and guests' accounts, manually or using computer systems.

Compute bills, collect payments, and make change for guests. Record guest comments or complaints, referring customers to managers as necessary. Review accounts and charges with guests during the check out process. Transmit and receive messages, using telephones or telephone switchboards. Advise housekeeping staff when rooms have been vacated and are ready for cleaning. Answer inquiries pertaining to hotel services, guest registration, and travel directions, or make recommendations regarding shopping, dining, or entertainment. Date-stamp, sort, and rack incoming mail and messages.

I was able to attribute 12% of the rise in accommodations from 2010-2012 during peak-season and Holiday months and 67% in booking the banquet rooms within 6 months, acquiring and solidifying accommodations amid a high competitive town with 8 other strongly branded hotels and motels in the area. Building strong relationships with the local Community, University and Tourism Organization to brand the hotel and promote continual flow of occupancy during the year

Answering customer calls and actively listening to identify their issues.Building customer relationships, earning their loyalty and trust. Troubleshooting problems and resolving a range of customer issues from device, to billing, to service concerns.
Generating excitement for new solutions and products that can enhance their experience. Ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems on the spot. Asked open-ended questions to assess customer needs. Scored in top 10% of employees in successful resolution of issues. Built long-term customer relationships and advised customers on purchases and promotions. Recommended alternative items if product was out of stock. Developed reputation as an efficient service provider with high levels of accuracy. Directed calls to appropriate individuals and departments. Effectively communicated with and supported sales, marketing and administrative teams on a daily basis. Recipient of multiple positive reviews acknowledging dedication to excellent customer service.