Nakia Hawley
Houston,TX
Summary
Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
16
16
years of professional experience
Work History
Intake Care Senior Representative
Cigna Healthspring
Houston, TX
01.2016 - Current
- Assist providers with precertification and referral needs with Medicare products
- Clearly explained benefits, eligibility, provider status, workflows, guidelines, services and any other necessary information to providers
- Respond to incoming/outbound calls from providers as required to meet departmental goals
- Answer inquires, gathers information, resolves routine matters, and responds to minor complaints or concerns
- Complete health assessments, maintain documentation for regulatory review
- Accurately recorded calls and resolution
- Worked in a cooperative manner with other departments.
- Trained new hires on customer service processes and protocols.
Customer Care Specialist/Medical Claims Processor
Aetna
Houston, TX
01.2012 - 01.2016
- Interfaces with customers via telephone, written correspondence, fax, web, and/or electronic mail to respond to inquiries and resolve concerns, including those of a difficult and challenging nature
- Respond to inquiries including, but not limited to benefits, enrollment, subsidies, provider and claims related authorizations, payments, denials, coordination of benefits, and eligibility
- Anticipates and quickly identifies and responds to customer needs
- Acts independently and manages own activities with minimal supervision and direction to meet customer needs using sound decision making
- Educates customers on various plan features
- Maintains phone quality and performance levels while working on customer-related projects
- Analyzes and approves routine claims that cannot be auto adjudicated
- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process
- Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues
- Routes and triages complex claims to Senior Claim Benefits Specialist
- Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member.
- Assisted customers with inquiries about products and services via phone, email, and chat.
- Provided timely responses to customer questions and complaints in a professional manner.
- Resolved customer issues efficiently by identifying problems, researching solutions, and following up on outcomes.
Customer Service Associate
Promark Research
Huntsville, TX
01.2011 - 01.2012
- Market Development conduct interviews with customers over the phone and record their responses accurately.
- Conducted in-person and telephone surveys to obtain demographic information from respondents.
- Analyzed data collected and identified trends in survey responses.
- Tracked progress of surveys and maintained accurate records of interviews conducted.
Supervisor
Aegis
Irving, TX
01.2009 - 01.2010
- Actively motivate individuals and the team toward achievement of performance metrics
- Maintained telephone skills to enable effective coaching and troubleshooting with Customer Care employees.
- Directed and supervised team of 15 employees in daily operations.
- Developed and implemented operational policies and procedures to ensure efficiency and accuracy of workflows.
- Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
- Tracked progress on projects and provided timely feedback to staff members.
- Conducted weekly meetings with team members to discuss upcoming tasks and project deadlines.
- Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
Customer Service Associate
Convergys
Longview, TX
01.2008 - 01.2009
- Listen attentively to customer needs and concerns; demonstrate empathy
- Meet customer requirements through first contact resolution
- Confirm customer understanding of the solution and provide additional customer education as needed.
- Greeted customers and identified their needs.
- Provided information about products and services available to customers.
- Processed customer orders accurately and efficiently.
- Resolved customer inquiries in a timely manner.
Education
Some College (No Degree) - Health Administration
University of Phoenix
Tempe, AZSkills
- Telephone Etiquette
- Customer rapport
- Relationship Building
- Records Management
- Customer Support
Timeline
Intake Care Senior Representative
Cigna Healthspring
01.2016 - Current
Customer Care Specialist/Medical Claims Processor
Aetna
01.2012 - 01.2016
Customer Service Associate
Promark Research
01.2011 - 01.2012
Supervisor
Aegis
01.2009 - 01.2010
Customer Service Associate
Convergys
01.2008 - 01.2009
Some College (No Degree) - Health Administration
University of Phoenix
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