NAKIA ALI
Buford,Georgia
Summary
Customer Service Representative with 10 years of experience in healthcare and retail sectors, adept at resolving complex inquiries and enhancing customer satisfaction. Skilled in multi-tasking, navigating dual monitors, and utilizing MS Office Suite and Avaya systems. Demonstrates strong communication and problem-solving abilities, consistently meeting performance metrics and improving resolution rates.
Overview
22
22
years of professional experience
Work History
Customer Service Representative
Primetherapeutics Rx (Remote)
02.2017 - 02.2025
- Answering calls from members, pharmacies, and healthcare providers regarding their pharmacy benefits.
- Clearly explaining coverage details, including co-pays, deductibles, and formulary restrictions.
- Assisting with prescription orders, verifying coverage, and addressing any potential issues.
- Investigating and processing prior authorization requests for specific medications.
- Troubleshooting rejected claims, and assisting with claim disputes.
- Identifying complex issues, and escalating them to the appropriate team when necessary.
- Adhering to HIPAA regulations and maintaining patient confidentiality.
Customer Service Representative
Kaiser Healthcare (Remote)
07.2017 - 05.2024
- Addressed caller concerns by providing accurate information about benefits, qualifications, and available services.
- Resolved customer concerns by conducting in-depth research, achieving high-resolution rates.
- Addressed inquiries regarding Medicare, billing, and tax forms.
- Responded to inquiries about facility issues, web support, and order ID cards.
- Directed members to appropriate departments efficiently.
- Resolved complex customer inquiries efficiently, enhancing member satisfaction, and reducing call escalations for Kaiser Healthcare's diverse clientele.
Customer Service Representative
Dental Quest (Remote)
02.2003 - 11.2009
- Provided assistance to providers by addressing questions regarding the members' dental insurance. As well as addressing members' questions regarding their dental insurance plan.
- Explaining coverage details, including deductibles, copay, and maximum benefits, to members.
- Assisting with claim submission, verifying eligibility, and addressing claim status inquiries.
- Helping members locate in-network dental providers based on their location.
- Investigating and resolving billing disputes, payment issues, or other customer concerns.
Education
General High School Diploma -
Mill Creek High School
Hoschton, GA05.2012
Skills
- MS Office Suite
- CRM
- Zendesk
- Avaya
- Citrix
- Excel
- Navigating between dual monitors
- Typing proficiency
- Conflict resolution
- Customer relationship management
Accomplishments
- Nominated for Rising Star Award for perfect attendance, 100% quality scores, and amazing 95% NPS score.
- Promoted to Team Lead
- Perfect score on customer surveys
Timeline
Customer Service Representative
Kaiser Healthcare (Remote)
07.2017 - 05.2024
Customer Service Representative
Primetherapeutics Rx (Remote)
02.2017 - 02.2025
Customer Service Representative
Dental Quest (Remote)
02.2003 - 11.2009
General High School Diploma -
Mill Creek High School
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