Nicole Lumives

• Conducted thorough investigations into member grievances regarding services, coverage, and claims disputes.
• Maintained detailed records summarizing investigations, root causes, and resolution outcomes.
• Crafted over 50 written resolutions for customer complaints, enhancing satisfaction by 30%.
• Performed witness interviews and document reviews to support grievance resolutions.
• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Learned and adapted quickly to new technology and software applications.
• Adaptable and proficient in learning new concepts quickly and efficiently.
• Passionate about learning and committed to continual improvement.
• Excellent communication skills, both verbal and written.

• Gather, analyze, report and resolve verbal and written post service appeal complex cases to ensure resolutions complied with relevant laws and policies.
• Drafted comprehensive written responses outlining outcomes of appeal or grievance filings.
• Resolved over 100 post-service appeals and grievances, improving service quality through detailed reporting.
• Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.

• Served as primary contact for Stanford Healthcare Medical Group members, ensuring effective communication.
• Resolved customer conflicts through strategic solutions, enhancing overall service quality.
• Assisted callers with inquiries related to health plans, medical claims, and billing issues.
• Responded to customer requests, offering excellent support and tailored recommendations to address needs.
• Followed up with customers about resolved issues to maintain high standards of customer service.
• Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.

• Created tailored vacation packages including flights, cruises, hotels, and car rentals.
• Researched optimal hotel and airfare selections to improve client satisfaction.
• Delivered exceptional customer service, building lasting relationships and securing new travel assignments.
• Specialized in cruise options from Carnival, Celebrity, Royal Caribbean, Princess, and NCL.
• Recommended travel insurance plans to customers to reduce uncertainty and risk of financial loss.
• Maintained up-to-date knowledge of travel industry trends, regulations and best practices to better serve customers.

• Managed HR support and benefit administration for multi-channel contact center operations.
• Educated customers on navigating employer benefit plans, ensuring efficient enrollment and changes.
• Effectively addressed complex issues by managing escalated calls as team lead assistant.
• Contributed to development of training programs for new staff members.
• Resolved problems related to benefits, eligibility and claims.
• Helped members navigate enrollment process and choose appropriate options.
• Resolved customer complaints using established follow-up procedures.
• Helped address client complaints through timely corrective actions and appropriate referrals.

• Processed federal and state income tax returns for individuals and small businesses, ensuring compliance with current tax laws.
• Identified potential deductions and credits for clients using tax software to maximize returns.
• Utilized tax software to prepare returns and meet deadlines.

Service for The Ambassador Chicago Hotel

• Managed reservations system to maintain accurate booking records and availability.
• Operated PBX for room service orders, ensuring knowledgeable recommendations and timely deliveries.
• Delivered concierge services while efficiently handling diverse guest requests.
• Scheduled and confirmed restaurant reservations for guests.
• Maintained high level of professionalism and discretion when dealing with guests.
• Responded to guest inquiries to maximize guest satisfaction.