Nicky Rivera
Tampa,Florida
Summary
Detail-oriented Remote Customer Care Specialist with expertise in healthcare and insurance. Skilled in managing high-volume calls, coordinating patient care, and ensuring accurate insurance verification. Committed to maintaining HIPAA-compliant documentation and delivering exceptional multichannel customer support in remote settings.
Overview
12
12
years of professional experience
Work History
Remote Customer Care Specialist
Tenant Health
01.2024 - Current
- Handle high-volume inbound and outbound calls to assist patients with scheduling, referrals, follow-ups, and general healthcare needs.
- Schedule and coordinate doctor appointments for new and existing patients, ensuring accurate provider and appointment information.
- Coordinated with patients, providers, and internal teams to facilitate smooth patient experiences and ensure timely access to care.
- Processed and coordinated patient referrals, ensuring accurate documentation and routing to appropriate providers for improved care transitions.
- Perform insurance verification to confirm patient eligibility, coverage, and relevant insurance information prior to appointments.
- Maintained and updated patient profiles by reviewing records for accuracy and completing necessary demographic, insurance, and appointment details to enhance patient experience.
- Review and clean up daily appointment reports to ensure scheduled appointments are accurate, complete, and properly documented.
- Maintain HIPAA compliance and protect confidential patient information while documenting patient interactions accurately.
- Consistently achieve 100% Quality Assurance audit scores while meeting company standards for accuracy, productivity, and customer service.
Patient Care Advocate
Cigna
01.2020 - 01.2024
- Provided end-to-end patient support in a fully remote healthcare and insurance environment.
- Managed patient records, insurance claims, and documentation to ensure compliance with HIPAA regulations.
- Resolved 90%+ of customer issues on first contact, reducing escalations and repeat contacts.
- Resolved over 90% of customer issues on first contact, minimizing escalations and the need for repeat contacts.
- Assisted patients with prescription-related questions and worked with providers and insurance teams to help resolve coverage and authorization issues.
- Assisted patients with prescription inquiries and collaborated with providers and insurance teams to address coverage and authorization challenges.
- Contacted doctors’ offices and provider teams to request prescription information, supporting documentation, and medication refills.
- Processed healthcare claims and prior authorization requests for patient prescription medications and refills.
Healthcare Advocate
Get Insured
01.2018 - 01.2020
- Achieved quality and productivity targets in high-volume virtual call center.
- Delivered multichannel customer support via phone and live chat, guiding members through insurance application process.
- Facilitated profile unlocking and resolved account access issues for members.
- Assisted members with unlocking their profiles and resolving account access issues.
- Maintained strong quality and productivity metrics in a high-volume virtual call center.
Car Buying Specialist
LKQ
01.2017 - 01.2018
- Negotiated vehicle purchases below market value, enhancing profit margins.
- Implemented streamlined inspection processes, increasing efficiency and accuracy.
- Coordinated sales and logistics teams to ensure timely inventory turnover.
Sales Manager
Rooms To Go
01.2015 - 01.2017
- Coached sales teams to consistently exceed performance and revenue targets.
- Developed strong customer relationships through effective consultative selling techniques.
- Implemented strategies that enhanced customer satisfaction and increased repeat business.
Education
Associate of Science - Information Technology
Southern New Hampshire University (SNHU)
01.2024 -
Skills
- Healthcare Customer Advocacy
- Remote Customer Support (Phone & Chat)
- Patient Referrals & Care Coordination
- Appointment Scheduling
- Insurance Verification
- HIPAA Compliance & Confidential Data Handling
- Quality Assurance & Audit Performance
- Performance Metrics
- CRM & Referral Management Systems
- Insurance & Provider Network Navigation
- Conflict Resolution & De-escalation
- Remote Team Collaboration
Remote Work Readiness
- Dedicated home office with reliable high-speed internet.
- Experienced with remote phone systems, referral platforms, and CRM tools.
- Dependable, self-motivated, and comfortable meeting strict performance metrics.
Timeline
Associate of Science - Information Technology
Southern New Hampshire University (SNHU)
01.2024 -
Remote Customer Care Specialist
Tenant Health
01.2024 - Current
Patient Care Advocate
Cigna
01.2020 - 01.2024
Healthcare Advocate
Get Insured
01.2018 - 01.2020
Car Buying Specialist
LKQ
01.2017 - 01.2018
Sales Manager
Rooms To Go
01.2015 - 01.2017