Nicole DeMauro
Pittsburgh,PA
Summary
Dedicated professional with extensive experience in authorization management and customer care. Skilled in effective communication, attention to detail, and critical thinking, ensuring timely resolution of inquiries and improved client satisfaction. Ready to leverage expertise for impactful organizational support.
Overview
7
7
years of professional experience
Work History
Prior Authorization Representative
Cigna
Bloomfield , CT
07.2022 - Current
- Communicated with healthcare providers to gather essential documentation for authorizations.
- Utilized internal systems for efficient tracking and management of authorization requests.
- Resolved client inquiries regarding authorization status and procedures in a timely manner.
- Maintained accurate electronic records of authorizations to ensure compliance and accessibility.
- Responded promptly to inquiries from providers, members, and various departments.
- Scheduled peer-to-peer reviews for physicians to discuss medical necessity with insurance providers.
- Identified process improvement opportunities related to prior authorizations for enhanced efficiency.
Customer Care Representative
CVScaremark
Woonsocket, Rhode Island
05.2019 - 06.2022
- Resolved customer inquiries regarding prescriptions and medication details with expertise in communication.
- Processed medication orders efficiently, ensuring accuracy through internal systems.
- Educated customers on insurance coverage and pharmacy policies for enhanced understanding.
- Addressed and resolved customer complaints promptly with professional problem-solving skills.
- Provided fast, knowledgeable service for routine questions and service issues.
- De-escalated conflicts using proven mediation techniques to maintain client satisfaction.
Education
Associate of Arts - Business Management
The Art Institutes
Pittsburgh, PA06-1993
High School Diploma -
East Allegheny High School
North Versailles, PA06-1990
Skills
- Authorization management
- Effective communication
- Time management
- Attention to detail
- HIPAA compliance
- Critical thinking
- Pharmacy benefit management
- Claims processing
- Utilization review
Timeline
Prior Authorization Representative
Cigna
07.2022 - Current
Customer Care Representative
CVScaremark
05.2019 - 06.2022
Associate of Arts - Business Management
The Art Institutes
High School Diploma -
East Allegheny High School