Summary
Overview
Work History
Education
Skills
Timeline
Generic

Rekayla Nelson

Tampa,FL

Summary

I have a strong ability to Facilitate positive and productive interactions between workers, leaders and union representatives. While also having a Successful background reaching consensus and smoothing relations to maximize success of negotiations. I'm able to Articulate and decisive professional with respectful and resourceful approach. I'm Organized and dependable candidate successful at managing multiple priorities with a positive attitude- As well as Willingness to take on added responsibilities to meet team goals. I'm Hardworking and passionate job seeker with strong organizational skills eager to secure an entry-level position. Ready to help team achieve company goals.

Overview

9
9
years of professional experience

Work History

Sr. Appeals and Grievances Coordinator

CVS Pharmacy
04.2023 - Current
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
  • Submitted verbal and written notification to members and providers.
  • Optimized departmental workflow through periodic assessment of current processes, identifying areas for improvement to increase overall effectiveness.
  • Streamlined case management by implementing a well-organized tracking system for all incoming appeals and grievances.
  • Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.

Senior Customer Service Supervisor

Conduent
02.2022 - 02.2023
  • Monitored customer feedback to identify areas of improvement in customer experience.
  • Empowered staff to take ownership of their roles, fostering a sense of responsibility that contributed to the overall success of the department.
  • Managed a team of customer service representatives, ensuring timely resolution of client inquiries and issues.
  • Introduced tools such as CRM systems to help track customer interactions more effectively, leading to better-informed decision-making processes within the organization.
  • Implemented quality assurance measures to maintain consistency in service delivery across the team.
  • Led monthly meetings with the team, discussing performance metrics and setting goals for continuous improvement.
  • Handled escalated customer complaints with empathy and professionalism, resolving issues quickly while maintaining positive relationships with clients.

Customer Service Representative

Humana
05.2020 - 01.2022
  • Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
  • Processed policy updates and changes accurately, ensuring client needs were met in a timely manner.
  • Handled sensitive customer information with discretion, adhering to strict data privacy regulations at all times.
  • Documented customer interactions and transactions for accurate, up-to-date records.
  • Processed insurance policy cancellations and renewals quickly to meet call time targets.
  • Fielded customer complaints, escalating complex issues to management for resolution.
  • Assessed customer needs and recommended suitable insurance policies.
  • Monitored ongoing industry developments and made recommendations for policy updates, helping to maintain the company''s competitive edge in attracting top talent.

HR Administrator

SeaWorld Parks & Resorts
04.2015 - 07.2017
  • Updated HR database with new employee information, changes in benefits, and other details.
  • Ensured accurate record-keeping by conducting regular audits of personnel files and HR databases.
  • Reduced time spent on administrative tasks by automating key processes.
  • Assisted employees with benefits enrollment, ensuring accuracy of information and timely processing of forms.
  • Served as a knowledgeable resource for all staff members regarding company policies, procedures, benefits, and other HR-related matters.
  • Improved employee satisfaction and performance with targeted training initiatives.
  • Administered performance evaluations to provide constructive feedback and identify ideal candidates for promotion.
  • Coordinated implementation of people-related services, policies and programs through departmental staff.

Education

Bachelor of Science - Science

Southern University And A & M College
Baton Rouge, LA
05.2021

Skills

  • Policy Knowledge
  • Dispute Resolution
  • Assertiveness
  • Complaint Handling
  • Grievance handling
  • Risk Management
  • Performance Management
  • Policy Development
  • Technical Documentation
  • ICD-10 Proficiency
  • HIPAA Compliance
  • Medical Terminology Familiarity

Timeline

Sr. Appeals and Grievances Coordinator

CVS Pharmacy
04.2023 - Current

Senior Customer Service Supervisor

Conduent
02.2022 - 02.2023

Customer Service Representative

Humana
05.2020 - 01.2022

HR Administrator

SeaWorld Parks & Resorts
04.2015 - 07.2017

Bachelor of Science - Science

Southern University And A & M College

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Rekayla Nelson