Summary
Overview
Work History
Education
Skills
Timeline
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NICOLE KENNEDY

Los Angeles,CA

Summary

Results-driven Claim Representative with one in a halfs years of experience at Molina, embodying the company's values and growth mindset. Seeking opportunities to leverage my expertise and contribute to the continued success of Molina by expanding my role and responsibilities within the organization. Committed to delivering exceptional customer service, ensuring accurate claims processing, and upholding Molina's commitment to excellence in the healthcare insurance industry.

Overview

19
19
years of professional experience

Work History

Customer Service Representative II

Molina Healthcare
Long Beach, CA
08.2021 - Current


  • Deliver accurate claim information i.e. claim status including denial reason, paid date, and other important information.
  • Assist providers with eligibility/enrollment status, claims authorizations, appeal and claim disputes.
  • Investigate discrepancies with claim denials.
  • Ensure HIPAA protocols are being met.
  • Answer 50+ incoming calls with a desire to problem solve.
  • Provide exceptional customer service to providers and Third Party Billers.
  • Research and verify with various software's.
  • Provide detailed documentation of inquires and resolution.

Home Health Care Provider

IHSS - In Home Supportive Services
Los Angeles, CA
12.2009 - 12.2020
  • Monitored progress and documented patient health status changes to keep care team updated.
  • Helped patients safely transition between sleeping surfaces and mobility assistance such as wheelchairs by providing consistent support.
  • Interacted kindly with patients and families and displayed positive, outgoing attitude, resulting in establishment of long-term, professional relationships.
  • Completed household management tasks for clients within private home settings.

Census Field Supervisor

US Census Bureau
Los Angeles, CA
07.2020 - 11.2020
  • Supervised a team of field enumerators, providing guidance and support to ensure the timely and accurate completion of assigned tasks.
  • Conducted comprehensive training sessions for enumerators, covering census protocols, data collection procedures, and adherence to privacy and confidentiality regulations.
  • Assigned and monitored workload distribution, ensuring optimal coverage and efficiency in data collection activities.
  • Developed and implemented quality control measures to validate the accuracy and completeness of collected data.
  • Conducted regular field visits to observe enumerator performance, address any challenges, and provide ongoing training and feedback.
  • Resolved escalated issues and inquiries from field staff, community members, and stakeholders in a professional and timely manner.
  • Collaborated with local community organizations and leaders to build relationships and facilitate cooperation during data collection.
  • Compiled and analyzed field reports, identifying trends, patterns, and areas for improvement to enhance data collection processes.
  • Prepared and submitted accurate and detailed reports on field operations, progress, and challenges to higher-level management.
  • Ensured compliance with census policies, procedures, and deadlines, maintaining the highest standards of data integrity and security.

Janitor

Spectrum Services Group, Inc.
Sacramento, CA
06.2019 - 06.2020
  • Cleaned and maintained doctor offices and common areas within the Family Counseling Department of the Los Angeles Veteran Department.
  • Followed established cleaning protocols and procedures to ensure compliance with health and safety regulations.
  • Sanitized surfaces, including desks, chairs, and examination tables, to prevent the spread of germs and maintain a clean environment.
  • Swept, mopped, and vacuumed floors to keep them free of debris and maintain a polished appearance.
  • Emptied trash bins and replaced liners, ensuring proper waste disposal and adherence to recycling guidelines.
  • Restocked supplies, such as paper towels, soap dispensers, and toilet paper, to ensure availability for staff and visitors.
  • Monitored and reported any maintenance issues or repairs needed to maintain a functional and presentable work environment.
  • Collaborated with department staff to address specific cleaning needs and accommodate scheduling requirements.
  • Upheld high standards of professionalism and confidentiality while working in sensitive areas within the Family Counseling Department.
  • Followed established security protocols to maintain the privacy and safety of veterans and their families.
  • Answered customer inquiries involving rates, products and loan application status to facilitate quality customer service.
  • Educated customers on variety of loan products and available credit options to promote valuable decision-making.
  • Submitted loan applications to underwriter for verification and recommendations.
  • Met with applicants to obtain information for loan applications and answer questions about process.

Program Manager (Contracted)

Polishing The Professional
Marina Del Rey, CA
04.2010 - Current
  • Interacted with customers and clients to identify business needs and requirements.
  • Coached team members on productivity strategies to accomplish challenging goals.
  • Addressed and resolved technical, financial, and operational concerns by working with team members and directors.
  • Met with project stakeholders on regular basis to assess progress and make adjustments.
  • Identified issues, analyzed information and provided solutions to problems.

EMERGENCY ROAD SERVICE DISPATCHER

AAA Auto Club Group
NASHVILLE, TN
05.2005 - 10.2006
  • Answered incoming calls from AAA members, assessed their needs, and accurately recorded service requests.
  • Gathered essential information from callers, including location, vehicle details, and the nature of the issue, to facilitate efficient dispatching.
  • Utilized computer systems and software to enter and track service requests, ensuring accurate documentation and timely updates.
  • Coordinated with contracted and non-contracted tower truck providers to dispatch them to the location of the member's vehicle.
  • Maintained constant communication with tower truck providers, monitoring their progress and providing necessary updates to AAA members.
  • Acted as a liaison between AAA members and tower truck providers, providing excellent customer service and addressing any concerns or issues.
  • Followed established protocols and guidelines to prioritize service requests based on urgency and member preferences.
  • Handled difficult or escalated situations with professionalism and empathy, ensuring member satisfaction and resolution of issues.
  • Assisted in monitoring and optimizing dispatch operations, identifying opportunities for process improvement and efficiency.
  • Collaborated with team members and supervisors to share knowledge, best practices, and ensure seamless service delivery.

Education

High School Diploma - Health Administration

King/Drew Medical Magnet High School
Los Angeles, CA

Certification Of Medical Billing & Coding - Health Administration

National College of Business And Technology
Nashville, TN

Skills

  • Documentation Review
  • Insurance Claim Forms Review
  • Verbal and Written Communication
  • Problem-Solving
  • Teamwork and Collaboration
  • Coverage Determination
  • Data Entry
  • Critical Thinking
  • Organizing and Prioritizing Work
  • Active Listening
  • Attention to Detail
  • Policy and Procedure Explanations
  • Claim Amount Calculations
  • Small Claims Payouts
  • Eligibility Determination
  • Customer Service

Timeline

Customer Service Representative II

Molina Healthcare
08.2021 - Current

Census Field Supervisor

US Census Bureau
07.2020 - 11.2020

Janitor

Spectrum Services Group, Inc.
06.2019 - 06.2020

Program Manager (Contracted)

Polishing The Professional
04.2010 - Current

Home Health Care Provider

IHSS - In Home Supportive Services
12.2009 - 12.2020

EMERGENCY ROAD SERVICE DISPATCHER

AAA Auto Club Group
05.2005 - 10.2006

High School Diploma - Health Administration

King/Drew Medical Magnet High School

Certification Of Medical Billing & Coding - Health Administration

National College of Business And Technology

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NICOLE KENNEDY