Nicole Seville

• Handling 40 to 50 inbound calls daily from members in a fast-paced inbound call center environment.
• Documenting accurate details of inquiries, comments, or complaints, transactions, or interactions records all actions taken in accordance with the request or question being asked.
• Explaining insurance coverage and supplemental benefits.
• Reviewing and submission of insurance authorizations, organization determinations, and procedures for members in need of specialists.
• Submitting grievances and/or appeals on numbers' behalf, providing grievance and appeal status, and revoking grievances per number request.
• Member portal/website troubleshooting.
• Scheduling, canceling, and activating trips for member medical visits.
• Reviewing claims, and submitting claim adjustment requests.
• Subject Matter Expert.
• Advanced chat expert-supporting agents who are in need of additional assistants while on complex calls.

Highlights:

• Provider services assistance project: assisting with provider claim status and adjustment requests.
• OJT Squad Leader.
• General SME.
• Producer Level 2 Training

• Monitored supplier operations to verify quality, delivery schedule, and conformance to contract specifications.
• Set and manage performance benchmarks for call center employees.
• Assisted with complex customer complaints and general inquiries in compliance with the NC plumbing board.
• Analyzed reports on improvement and improving the efficiency of the call center and overall business needs.
• Consulted with customers to determine the best methods to resolve service and billing issues.