Mia Nelson
Houston,Texas
Summary
Supported customer service operations with 25 years of experience in healthcare. Assisted in managing high-volume claims operations for over 5 years in insurance and healthcare sectors. Contributed to customer call center environments for over 20 years. Aided in improving turnaround times, reducing error rates, and enhancing customer satisfaction through process improvements and team support. Assisted in regulatory compliance auditing and workflow optimization to maintain organizational reputation while achieving efficiency gains. Recognized for mentoring teams, streamlining claims management systems, and implementing solutions that promote accuracy and operational excellence.
Overview
19
19
years of professional experience
Work History
Customer Service / Claims Team Lead
Manhattan Life Assurance
11.2020 - 03.2025
- Achieved operational excellence by managing daily activities for a team of 30 examiners, resulting in enhanced claims processing accuracy and efficiency. Processed 80 claims daily while successfully training new hires. Implemented a new claims tracking system that increased claim visibility and improved customer response times. Leveraged Salesforce and QNXT AS400 and Connections to support daily operations. Identified discrepancies and trends through claims data analysis, leading to process improvements that significantly reduced error rates and backlog. Participated in audits to maintain regulatory compliance, protecting company reputation and minimizing risks. Enhanced examiner performance through targeted mentoring and coaching, developing tools and training methods that simplified claims processing. Increased customer satisfaction and reduced turnaround times by streamlining workflows and proactively addressing operational challenges.
Customer Service Coordinator
Group 1
01.2016 - 03.2020
- Directed daily operations as lead service coordinator, managing 60 to 80 calls and overseeing maintenance appointment scheduling. Developed a client feedback system to capture insights, enhancing customer loyalty and refining service offerings. Mentored junior staff to build team capabilities and promote a culture of continuous improvement.
Benefits/Claims Specilist
United Behavioral Health
11.2005 - 08.2012
- Achieved efficient handling of 50 to 60 calls per day, delivering critical benefit information to patients and providers. Rectified claims errors through thorough analysis and support. Enhanced patient intake experiences with empathetic guidance, resulting in reduced onboarding time and smoother care transitions. Drove collaboration among multidisciplinary teams to assess patient needs, leading to personalized treatment plans and improved communication. Advanced quality assurance efforts by identifying key opportunities for enhancing patient care and service delivery. Elevated team performance by training examiners on precise claims processing, ICD-10 coding, and error correction.
Education
No Degree - Healthcare Administration
San Jacinto Community College
Houston, TXSkills
- Team Leadership
- Coaching
- Process Improvements
- Performance Metrics
- Regulatory Compliance
- Auditing
- Program Management
- Customer Engagement
- Conflict Resolution
- Data Analysis
- Reporting
- Qnxt
- Salesforce
- Data entry
- Medical records reviewer
- Appeals and grievances
- Medicare
- Medicaid
- Managed care claims
- Dental claims
- Disability claims
- Cm1500 forms
Timeline
Customer Service / Claims Team Lead
Manhattan Life Assurance
11.2020 - 03.2025
Customer Service Coordinator
Group 1
01.2016 - 03.2020
Benefits/Claims Specilist
United Behavioral Health
11.2005 - 08.2012
No Degree - Healthcare Administration
San Jacinto Community College