Nicole Catchens
Oak Park,Michigan
Summary
Dedicated Intake Specialist skilled in claim eligibility analysis and records management. Excellent communication and interpersonal skills. Familiar with industry standards and requirements. Managing duties to facilitate smooth workflow and operational efficiency.
Nicole Catchens is a Customer Care & Service Professional with over 8 years of hands-on expertise assisting customers around the world with maximum care and concern. Nicole endeavors to maintain a high level of professionalism, patience and efficiency to minimize customer dissatisfaction and increase customer loyalty. Nicole’s expertise is customer care, research and fact-finding for problem resolution, administrative management and team leadership.
Overview
18
18
years of professional experience
Work History
Appeals & grievance Intake Specialist
Health Alliance Plan
04.2022 - Current
- Ensures daily case receipt via mail, fax, email, Customer Message Center and
HAP’s documentation application Pega (Customer Services Specialists), and vendor
sites. Responsible for investigation, assignment and tracking for Appeals,
Reconsiderations, Redeterminations, and Grievances and entry into care
management system. Ensures adherence to CMS, NCQA, and DOL regulatory and
compliance guidelines. - Assists Appeal and Grievance Analyst in providing case data to support all internal
and external reporting. Maintains the Access database as the source for
departmental information to support Data Validation, NCQA, Medicare 5 Star, MARS
and other initiatives. - Responsible for providing all case documentation for External Review requests by
DIFS, OPM, MAXIMUS, etc. - Works with leadership to create and update Correspondences for Medicare
Advantage and Commercial members and providers while ensuring compliance with
regulatory entities. - Works with Client Services Training department to create and maintain updated
documents and desk level procedures to ensure new and current staff have
resources available for continuing education. - Provides administrative support to the Appeal and Grievance Manager and the
Appeal and Grievance Analyst. Maintains professionalism and confidentiality and
orders departmental supplies. Organizes and oversees the annual case purge
performed by the Clerical team. - Ensures meetings are scheduled as required and proper materials are prepared,
distributed and presented as all meetings including but not limited to departmental,
Grievance Pre Hearing and Grievance Committee Hearings. - Performs record and document searches, collection and submission for the Legal Department.
- Creates statistical weekly, monthly and annual reports for Appeals and Grievances
activity providing rationale when the activities are skewed; compile annual reporting
data using charts and MS Power Point for distribution to internal leadership. - Establishes and maintain strong relationships and contacts across departments in
addition to external contacts to ensure open communication, team effort and positive
work relations. Continues to self-educate on changes in policies and procedures that
occur in other departments that could have an impact on the Appeal and Grievance
department operations and the servicing of member/customers. - Performs other related duties as assigned.
Government Customer Service Specialist
Health Alliance Plan, HAP
05.2018 - 04.2022
- Answers incoming customer calls regarding billing issues, product problems, service questions and general client concerns
- Responsible for maintaining a high level of professionalism with clients and working to establish a positive rapport with every caller
- Update customer information in the customer service database during and after each call
- Work with the management team to stay updated on product knowledge and be informed of any changes in company policies
- Impact the company’s bottom line by problem solving and turning frustrated clients into repeat customers.
Contact Center Advocate II
Henry Ford Health Systems
02.2017 - 05.2018
- Performs all duties of Patient Advocate I on a broader scale, including all of the Henry Ford Health System services and not limited to a specified practice group and/or multiple location
- Handle multi-channel contacts and interacts with physicians, administrators, patients, and all other stakeholders.
- Made referrals to appropriate services, following up to confirm patients received access to required care.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Assisted with new clinic set up
- Set up doctor profiles
Contact Center Advocate I
Henry Ford Health Systems
01.2015 - 02.2017
- Acts as a welcoming front door for all callers/customers, instilling loyalty and anticipating needs, while providing efficient, effective customer relationship management
- Follows established protocols to schedule patient appointments for specified practice groups and/or multiple locations
- Performs new patient registration; updates registration and insurance information; responds to telephone inquiries from all callers/customers; follows established protocols for prescription request and/or messaging.
New Faces Appointment Setter
One Source Talent
10.2014 - 01.2015
- Answer phones on a multiline phone system and direct calls as appropriate
- Call volume of 250 or more calls per day
- Set up initial appointments for new talent
- Place reminder calls for all appointments
- Cancel/re-schedule missed appointments
- Assist managers, talent agents and various other staff members as need/instructed.
Senior Research Specialist
North American Bancard
01.2014 - 08.2014
- Promoted to position after successful progress as agent support representative
- Facilitate advanced research requests from residual inquiries and merchant/agent inquiries
- Prioritize needs according to urgency, completing research tasks quickly and efficiently to maintain seamless business processes.
Agent Support Representative
North American Bancard
08.2010 - 01.2014
- Resolved approximately 150 daily emails, phone calls/voicemails from customers and merchants
- Authorized follow up/check on applications and equipment deployment to ensure company efficiency
- Organized deployment requests, credit/debits, bonus paperwork (i.e
- 30 deals/90 days, etc.)
- Provided general account maintenance including updating rates and fees.
Data Entry Specialist
North American Bancard
06.2007 - 08.2010
- Assist inbound callers with various account maintenance request from bank account changes, DBA/Corporate name changes and answer questions from new account holders
- Trained and guided newly employed staff group of 10 on building files and rate changes
- Activate and deactivate Wireless Terminals and assist with rate & fee updates
- Aided coworkers with any build questions and rate change concerns, helping to maintain a strong team environment and rapport.
Customer Service Representative
North American Bancard
07.2006 - 06.2007
- Advised over 100 incoming calls/voicemail from customers located around the world with various account queries and concerns
- Efficiently performed general account maintenance (adding American Express and Discover to accounts)
- Created Customer Service documents for merchants per request
- Pick up and deliver departmental forms, mail and other sensitive materials
- Tracked and documented all calls in TMS, proprietary database system software.
Education
Associate of Business Administration -
Oakland Community College
Bloomfield Hills, MI12.2024
High School Diploma -
Oak Park High School
Oak Park, MI05.1998
Skills
Data research and analysis
Proficiency in [Software]
Provider enrollment
Practitioner application monitoring
Expert in merchant service
Data Confidentiality
Issue Reporting
Client Screening
Report Generation
Payment Processing
Data Entry
Investigation tactics
Timeline
Appeals & grievance Intake Specialist
Health Alliance Plan
04.2022 - Current
Government Customer Service Specialist
Health Alliance Plan, HAP
05.2018 - 04.2022
Contact Center Advocate II
Henry Ford Health Systems
02.2017 - 05.2018
Contact Center Advocate I
Henry Ford Health Systems
01.2015 - 02.2017
New Faces Appointment Setter
One Source Talent
10.2014 - 01.2015
Senior Research Specialist
North American Bancard
01.2014 - 08.2014
Agent Support Representative
North American Bancard
08.2010 - 01.2014
Data Entry Specialist
North American Bancard
06.2007 - 08.2010
Customer Service Representative
North American Bancard
07.2006 - 06.2007
Associate of Business Administration -
Oakland Community College
High School Diploma -
Oak Park High School
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