Nicole Thomas
Management
Lakeland
Summary
Results-driven professional with expertise in operations management, process improvement, and customer service. Proven ability to enhance operational efficiency and foster strong client relationships.
Overview
2027
2027
years of professional experience
Work History
Operations Manager
MBGR Home Improvement /Construction
- Conducted regular performance reviews, identifying areas for improvement and developing action plans to address them.
- Supervised operations staff and kept employees compliant with company policies and procedures.
- Led hiring, onboarding and training of new hires to fulfill business requirements.
- Developed and implemented strategies to maximize customer satisfaction.
- Developed and maintained relationships with external vendors and suppliers.
- Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits.
- Scheduled employees for shifts, taking into account customer traffic and employee strengths.
Senior Claim Benefit Specialist /Medical Coding and Billing Specialist
Friday Health Plans
11.2022 - 12.2026
- Recognized as a subject matter expert in benefits administration, regularly consulted by peers for guidance on challenging cases.
- Nurtured relationships with key stakeholders, including agents, brokers, and healthcare providers.
- Improved claim processing efficiency by streamlining workflows and implementing new software tools.
- Collaborated with cross-functional teams to develop new product offerings tailored to client needs.
- Reduced claim resolution time with thorough investigations and efficient communication with policyholders and providers.
- Assisted legal department in the preparation of cases involving complex or high-value claims disputes when necessary.
- Followed up with customers on unresolved issues.
- Developed customized training materials to enhance the effectiveness of employee onboarding programs.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Processed and recorded new policies and claims.
- Verified client information by analyzing existing evidence on file.
- Checked documentation for accuracy and validity on updated systems.
- Calculated adjustments, premiums and refunds.
- Modified, updated and processed existing policies.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained confidentiality of patient finances, records, and health statuses.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posted payments to accounts and maintained records.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Generated, posted and attached information to claim files.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Enhanced customer satisfaction, addressing escalated concerns promptly and professionally.
- Evaluated the performance of team members regularly, providing constructive feedback for continuous improvement efforts.
- Identified trends in claims data, proposing changes to underwriting guidelines for risk mitigation purposes.
- Conducted periodic audits of internal processes to ensure adherence to established policies and regulatory requirements.
- Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
- Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
- Assisted patients with understanding their insurance coverage and financial responsibilities, fostering positive relationships and trust between the practice and its clients.
- Streamlined billing processes by implementing efficient coding practices, resulting in reduced errors and improved revenue generation.
- Maintained high levels of customer satisfaction through prompt resolution of disputes related to charges on patient accounts or insurance claims.
- Developed effective communication channels with insurance companies to facilitate prompt resolution of claim inquiries and disputes.
- Implemented cost-saving measures through strategic negotiations with medical facilities and service providers involved in claims disputes.
Quality Assurance Analyst
Wipro Corporate Office
03.2014 - 10.2022
- Mentored and coached team members on QA topics and strategies.
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration, and teamwork.
- Streamlined QA processes for increased efficiency and reduced time spent on redundant tasks.
- Participated in regular meetings with cross-functional teams to discuss progress updates, communicate concerns or challenges, and ensure alignment of project goals.
- Ensured customer satisfaction by verifying that products met specifications and functioned as intended before release.
- Collaborated with development teams to identify, track, and resolve software defects in a timely manner.
- Mentored new hires within the QA department, fostering a culture of teamwork and continuous learning.
- Kept scripts and test cases updated with current requirements.
- Assisted in the development of quality assurance policies, contributing to overall company success.
- Directed team of 15 personnel, overseeing records, performance, and quality assurance.
- Increased timely treatment protocols by leveraging current response and quality assurance requirements.
Education
Bachelor of Science - Applied Health Management
Northbridge University
Tampa, FL12-2028
Skills
Operations management
Problem-solving
Customer service
Process improvement
Team leadership
Business development
Operational efficiency
Management
Client relationships
Marketing
Project management abilities
Negotiation
Contract management
Process improvement strategies
Budget development and management
Risk management
Schedule management
Onboarding and orientation
Timeline
Senior Claim Benefit Specialist /Medical Coding and Billing Specialist
Friday Health Plans
11.2022 - 12.2026
Quality Assurance Analyst
Wipro Corporate Office
03.2014 - 10.2022
Operations Manager
MBGR Home Improvement /Construction
Bachelor of Science - Applied Health Management
Northbridge University