Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Interests
MVP, 2020
Timeline
Generic

Nicole Rader

Lake Waynoka,OH

Summary

Dedicated Service Escalation Account Manager with proven expertise in de-escalation and conflict resolution. Highly skilled in client relations and effective communication, consistently delivering timely and sustainable solutions to complex service issues.

Overview

1
1
Certification
10
10
years of professional experience

Work History

Service Escalation Account Manager

United Healthcare
08.2024 - Current
  • Manage complex, high-priority client escalations as primary contact to resolve service issues and achieve timely, effective outcomes.
  • Partner with internal teams across claims, customer service, operations, benefits, billing, and leadership to investigate root causes and implement sustainable solutions.
  • Build and maintain strong relationships with clients, providing clear communication, issue updates, and resolution strategies throughout the escalation process.
  • Analyze service trends, identify recurring issues, and recommend process improvements to enhance member and client satisfaction.

Customer Service Navigator

United Healthcare
02.2023 - 08.2024
  • Served as a knowledgeable point of contact for member questions, provided accurate and compassionate support, and resolved complex service issues.
  • Assisted members with navigating healthcare benefits, coverage, claims, providers, and available health plan resources.
  • Coordinated with internal departments, healthcare providers, and other stakeholders to investigate issues and facilitate timely resolutions.

Customer Service Advocate

United Healthcare
04.2022 - 02.2023
  • Delivered personalized support to members by resolving inquiries about health plan benefits, coverage, claims, eligibility, and provider services.
  • Advocate for members by coordinating with internal departments, healthcare providers, and other stakeholders to facilitate timely and accurate issue resolution.
  • Handle sensitive and confidential member information in accordance with HIPAA, company policies, and applicable privacy regulations.

Health Care Advisor

RDI Marketing
10.2019 - 11.2021
  • Developed and implemented patient engagement strategies to improve healthcare outcomes.
  • Collaborated with cross-functional teams to streamline communication between healthcare providers and patients.
  • Trained and mentored junior staff on best practices for patient advocacy and support services.

Patient Access Representative

Mercy Health Hospital
06.2016 - 07.2018
  • Managed insurance verification and eligibility checks to minimize payment delays.
  • Coordinated patient scheduling and registration processes to ensure timely service delivery.
  • Streamlined patient information collection through electronic health record systems for improved accuracy.
  • Educated patients on hospital services and procedures, enhancing overall patient experience.

Education

Bachelor of Science - Business Administration

Capella University
Minneapolis, MN
12.2023

Bachelor of Science - Biology

University of Cincinnati
Cincinnati, OH

MBA - Health Care Management

Capella University
Minneapolis, MN
06.2027

Associate of Science - Biology

University of Cincinnati
Cincinnati, OH
04.2020

Skills

  • Root Cause Analysis
  • Healthcare Regulations
  • Healthcare Operations
  • Account Management
  • Customer Service
  • Client Engagement
  • Multitasking
  • Excellent Communication
  • Conflict Resolution

Accomplishments

  • Successfully de-escalated irate members and patients by using active listening, empathy, and solution-focused communication to resolve complex and sensitive concerns.
  • Earned two promotions within two years based on demonstrated performance, reliability, customer service, and ability to take on increased responsibilities.
  • Selected as an On-the-Job Trainer (OJT) for a new-hire training class, providing hands-on guidance and sharing knowledge to help new employees successfully transition into their roles.
  • Selected to participate in a Change Champions campaign within three months of entering a new role, demonstrating early recognition for adaptability, communication skills, and ability to support organizational change.

Certification

  • Medicare & Retirement
  • Basic Life Support

Interests

  • I enjoy helping others and giving back to the community
  • Avid Reader
  • Tech enthusiast, passionate about exploring the latest advancements and innovations
  • Enjoy participating in hiking for overall physical and mental well-being

MVP, 2020

MVP Award — February 2020 | Optum

  • Awarded MVP for February 2020 in recognition of outstanding performance, resilience, leadership, and adaptability during a major transition from the HCA line of business to PHS.
  • Achieved a 95% quality assurance (QA) score and maintained an average handle time of 7 minutes, 39 seconds while completing the HCA campaign.
  • Demonstrated leadership during the PHS transition by actively participating in training and becoming the first team member to go live and take calls when the new line of business launched.
  • Recognized for the ability to remain composed under pressure, think quickly, embrace change, and support team success during a period of rapid operational changes.

Timeline

Service Escalation Account Manager

United Healthcare
08.2024 - Current

Customer Service Navigator

United Healthcare
02.2023 - 08.2024

Customer Service Advocate

United Healthcare
04.2022 - 02.2023

Health Care Advisor

RDI Marketing
10.2019 - 11.2021

Patient Access Representative

Mercy Health Hospital
06.2016 - 07.2018

Bachelor of Science - Biology

University of Cincinnati

Bachelor of Science - Business Administration

Capella University

MBA - Health Care Management

Capella University

Associate of Science - Biology

University of Cincinnati
Nicole Rader