NICOLE LUMIVES
Fresno,CA
Summary
Dependable employee with a strong desire to expand skills and make a meaningful contribution to company success. Known for being hardworking, ethical, and detail-oriented. Seeking an opportunity to utilize expertise and dedication in a dynamic work environment that values teamwork and innovation. Committed to delivering exceptional results and exceeding expectations in all tasks undertaken.
Overview
15
15
years of professional experience
Work History
Appeals and Grievance Coordinator I
Centene Corporation: Health Net
06.2024 - 10.2024
- Provided oversight of appeals and grievances process, ensuring compliance with applicable regulations.
- Analyzed complex cases to determine appropriate resolution in accordance with relevant laws, regulations and organizational policies.
Member Care Specialist
CareCounsel, LLC
11.2021 - 02.2024
- Provided high-level member support, leveraging thorough knowledge of all healthcare policies, products, and services.
- Responded to member inquiries while offering prompt service to advocate and resolve issues related to medical claims, billing, authorization, system navigation, appeals processing, and health plan coverage.
Health Concierge
Bswift, a Aetna Company-owned
04.2018 - 11.2021
- Provided Benefit administration for employees of companies nationwide.
- Helped members navigate enrollment process and choose appropriate options.
- Resolved problems related to benefits, eligibility and claims.
Independent Travel Agent
Avoya Travel / Hokunani Traveler
11.2022 - 10.2023
- Provided customers with best deals and well-researched travel options, successfully negotiating rates while improving customer satisfaction ratings.
- Recommended travel insurance plans to customers to reduce uncertainty and risk of financial loss.
Tax Preparer
Jackson Hewitt
10.2019 - 05.2020
- Prepared simple and complex tax filings for individuals and businesses.
Hospitality Agent
Zephyr
10.2017 - 04.2018
- Handled high guest loads through consistent use of preparation checklists and excellent multitasking abilities.
- Delivered excellent customer service to support company reputation and patron satisfaction.
Travel Consultant
Classic Vacations a Expedia company
12.2009 - 06.2012
- Planned and booked luxury domestic and international travel packages.
Education
Associate in Arts (A.A.) - Natural Science -
05.2018
High School Diploma - General - undefined
06.1995
Skills
- Strong computer skills (Microsoft Excel, Word, Office)
- Strong organizational, analytical, investigative, and problem solving skills
- Customer Support and Service
- Interpersonal Communication
- Teamwork and Collaboration
- Healthcare and Insurance knowledge
- Multitasking skills
- Conflict, and Dispute Resolution
Timeline
Appeals and Grievance Coordinator I - Centene Corporation: Health Net
06.2024 - 10.2024
Independent Travel Agent - Avoya Travel / Hokunani Traveler
11.2022 - 10.2023
Member Care Specialist - CareCounsel, LLC
11.2021 - 02.2024
Tax Preparer - Jackson Hewitt
10.2019 - 05.2020
Health Concierge - Bswift, a Aetna Company-owned
04.2018 - 11.2021
Hospitality Agent - Zephyr
10.2017 - 04.2018
Travel Consultant - Classic Vacations a Expedia company
12.2009 - 06.2012
Irvington High School - High School Diploma - General,
College of Alameda - Associate in Arts (A.A.) - Natural Science,
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