Nichol Boggs
Saint Michael,MN
Summary
Experienced healthcare operations professional with a strong background in eligibility analysis, claims processing, and prior authorizations. Skilled in resolving escalated issues, interpreting policies, and driving process improvements. Recognized SME with a focus on accuracy, compliance, and cross-functional collaboration.
Overview
9
9
years of professional experience
Work History
Escalation Supervisor
UnitedHealth Group
08.2023 - 05.2025
- Lead and mentor a team supporting complex service resolution, acting as a subject matter expert (SME) for high-priority, escalated eligibility, claims, pharmacy, authorization and coverage issues.
- Analyze member data, eligibility trends, and process deviations to identify root causes and develop compliant, data-driven solutions that improve operational accuracy.
- Ensure team adherence to Sources of Truth (SOT) and Standard Operating Procedures (SOPs), while also authorizing exceptions when warranted and justified by policy interpretation.
- Perform case audits and quality reviews to validate eligibility determinations, ensure regulatory compliance, and drive performance improvements.
- Collaborate with internal departments (e.g., claims, benefits, and IT) to resolve cross-functional eligibility issues and implement streamlined workflows.
- Forecast resource needs, manage priorities, and support innovation in eligibility operations while maintaining high standards of service excellence.
- Communicate effectively with stakeholders, translating complex information into clear, actionable insights for both internal teams and external partners.
Senior Customer Support Representative
UnitedHealth Group, USA
09.2021 - 08.2023
- Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
- Uses company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
- Learned and maintained in-depth understanding of product information, providing knowledgeable responses to diverse questions.
- Supported customer questions and issues by gathering data, analyzing needs, evaluating possible resolutions and implementing best solutions.
Administrative Assistant
Park Nicollet Orthotics And Prosthetics Department
11.2018 - 01.2021
- Verified insurance eligibility and obtained prior authorizations for managed patients charts.
- Managed Durable Medical Equipment vendor relationships to ensure timely delivery of supplies and services.
- Effectively managed the billing and coding process for Durable Medical Equipment.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Medical Receptionist
Park Nicollet Specialties Department
08.2016 - 11.2018
- Managed master calendar and schedule appointments for providers based on optimal patient loads and clinician availability.
- Verified patient insurance, demographic, and health history data to ensure accuracy and current records.
- Excellent communication and interpersonal skills
Skills
- Cross-Functional Team Collaboration
- Policy Interpretation & Regulatory Compliance
- Root Cause Analysis & Problem Solving
- Member Services & Escalation Resolution
- Team Leadership & Performance Coaching
- Workflow Optimization & Resource Planning
- Excellent Written & Verbal Communication
Timeline
Escalation Supervisor
UnitedHealth Group
08.2023 - 05.2025
Senior Customer Support Representative
UnitedHealth Group, USA
09.2021 - 08.2023
Administrative Assistant
Park Nicollet Orthotics And Prosthetics Department
11.2018 - 01.2021
Medical Receptionist
Park Nicollet Specialties Department
08.2016 - 11.2018
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