Nia Watson

Mentored team members on CRM functionality, call handling strategies, and compliance standards, enhancing overall team performance and service consistency. Supported cross-functional collaboration with nurse practitioners, brokers, and financial assistance teams to ensure continuity of care and member trust. Executed all tasks with speed, accuracy, and emotional intelligence answering calls within 3 seconds, maintaining 0% idle time, and achieving a 90% utilization rate, with 5/5 QA ratings on 90% of member interactions

• Resolved 10–12 daily claims and billing disputes using detailed benefit explanations and rapport-building techniques.
• Spearheaded seamless support for insurance updates and Kaiser Permanente transitions, increasing retention by 32%.
• Delivered 100% accurate provider transfers and patient intake coordination, ensuring continuity of care and compliance.
• Maintained average handle time of 5–7 minutes while proactively following up to ensure resolution and member trust.
• Supported demographic updates, MyChart access, and technical troubleshooting with precision and empathy.
• Collaborated with brokers, nurse practitioners, and financial assistance teams to resolve escalated member needs.
• Executed all tasks with speed, clarity, and emotional intelligence answering calls within 3 seconds and maintaining 0% idle time.

Supported California Medi-Cal members with multichannel service delivery, resolving complex inquiries related to benefits, claims, billing, provider coordination, and emergency requests. Delivered emotionally intelligent service across inbound, outbound, and triage calls, ensuring first-contact resolution and long-term member satisfaction. Managed 300–700 calls weekly with a 5–7 minute average handle time, maintaining 100% script adherence and a 0% abandonment rate. Answered calls within 3 seconds, sustained 0% idle time, and achieved a 90% utilization rate while navigating CRM platforms including Genesys, AS400, Avaya, and SharePoint.

• Increased member retention by 32% through seamless Kaiser Permanente transitions, clear benefit explanations, and emotionally resonant communication.
• Resolved 10–12 daily claims adjudications and billing disputes by verifying eligibility, reviewing EOBs, and applying first-contact resolution strategies.
• Delivered 100% accurate provider transfers and patient intake coordination, ensuring continuity of care and compliance with Medi-Cal protocols.
• Handled urgent requests, including emergency medication overrides, benefit escalations, and provider reassignments, with under 5-minute resolution time.
• Processed demographic updates, insurance changes, and MyChart access issues with precision, maintaining 100% data integrity and HIPAA compliance.

Provided remote support to clients of national pharmacy chains, independent pharmacies, and major insurance groups including Blue Cross Blue Shield, Humana, and Aetna. Delivered high-volume, emotionally intelligent service across inbound, outbound, triage, and emergency channels resolving complex pharmaceutical inquiries, benefit verifications, and prior authorization requests with speed, accuracy, and empathy. Managed 500–700 biweekly cases while leading a top-ranked team and earning promotion to Prior Authorization Representative and Team Lead in the absence of a supervisor.

• Handled 500–700 biweekly calls across multiple channels, including urgent medication requests, tier exchanges, benefit overrides, and pharmacy claim rejections.
• Verified insurance coverage, formulary status, and benefit eligibility for commercial plans (e.g., Blue Cross Blue Shield, Humana, Aetna), resolving inquiries within 5–10 minutes using Salesforce and SharePoint.
• Spearheaded expedited medical requests and emergency referrals for prior authorization cases involving post-operative pain management, behavioral health medications, insulin, and cardiac treatments coordinating with prescribers and insurance liaisons to prevent care delays.
• Processed tier exchanges for non-formulary or high-cost medications by reviewing plan alternatives, initiating override protocols, and documenting clinical justifications in compliance with CMS and HIPAA standards.
• Maintained a 0% abandonment rate by answering calls within 3 seconds, managing queue flow in Avaya, and triaging high-priority cases to ensure uninterrupted patient access to care.
• Navigated CRM platforms (Avaya, SharePoint, Salesforce) with sub-10 second task execution, ensuring 100% data accuracy across member profiles, authorization logs, and pharmacy records.
• Adhered to HIPAA, CMS, and insurance-specific compliance protocols, ensuring secure handling of PHI and proper documentation of override decisions and authorization outcomes.
• Mentored 12+ team members on CRM navigation, call handling techniques, and emotionally intelligent service strategies—resulting in a 20% increase in team QA scores and reduced escalations.
• Achieved 100% QA scores across performance benchmarks and earned consistent 10/10 customer satisfaction ratings through personalized, first contact resolutions.
• Reduced repeat callers by 60% through clear benefit education, proactive follow-ups, and customized solutions—resulting in a 35% increase in customer retention and long-term pharmacy-client trust.
• Collaborated with pharmacists, prescribers, and insurance representatives to expedite approvals, clarify coverage, and ensure continuity of care across complex medication workflows.