Nicolese Carbone
Port St Lucie,FL
Summary
Dynamic customer service leader with over 18 years of experience in healthcare, business, and service industries. Expertise in team leadership, escalation resolution, and process improvement while ensuring compliance with industry standards. Strong advocate for member satisfaction, recognized for exceeding quality goals and simplifying complex information to enhance understanding. Committed to professional development through completion of the UC Davis Leadership Program and currently pursuing a Certificate in Quality Customer Service.
Overview
10
10
years of professional experience
Work History
Grievance Caseworker
The Cigna Group
11.2022 - Current
- Surpassed SLA and quality benchmarks with 96–100% accuracy in case resolution.
- Managed high-volume Medicare Part D grievances ensuring CMS, HIPAA, and PBM compliance.
- Conducted root cause analysis to reduce repeat complaints and improve member experience.
- Partnered with cross-functional teams (clinical, compliance, account managers) to resolve escalations.
- Delivered empathetic communication to members navigating complex coverage issues.
- Mentored peers on documentation standards and resolution strategies; supported special projects.
- Recognized with Circle of Excellence Award and Plain Language Hero Award for member advocacy and clarity in communication.
Patient Care Advocate
The Cigna Group / Express Scripts
08.2021 - 11.2022
- Delivered empathetic service in high-volume call center.
- Resolved prescription, billing, and coverage issues.
- Facilitated patient engagement through effective communication and support strategies.
- Streamlined patient inquiries by implementing efficient response protocols, improving satisfaction rates.
Call Center Supervisor in Training
Amazon
02.2020 - 08.2021
- Exceeded performance goals with 95% QA scores across team and individual metrics.
- Coached and mentored agents to improve compliance, call quality, and ADA/FMLA case handling.
- Managed escalations and sensitive disability/leave cases ensuring regulatory compliance.
- Led daily huddles, monitored queues, and redistributed workload to maintain service levels.
- Developed training materials and job aids; collaborated with leadership to streamline processes.
- Acted as escalation point for complex cases, driving timely resolution and positive customer experience.
Business Office Manager
Complete Home Care
02.2016 - 02.2020
- Multi-Site Operations Management: Directed daily business functions across multiple locations, ensuring compliance with company standards and regulatory requirements.
- Team Leadership & Development: Supervised and coached 20+ employees; conducted evaluations, implemented corrective actions, and identified high-potential staff for advancement.
- Financial & Administrative Oversight: Managed billing, payroll, and accounts receivable; processed payroll for 140+ employees with accuracy and timeliness.
- Process Optimization: Streamlined workflows and introduced best practices, improving efficiency and reducing documentation errors by 30%.
- Compliance & Risk Management: Ensured adherence to HIPAA, labor laws, and state/federal regulations through audits and staff training.
- Employee Relations & Conflict Resolution: Served as liaison between staff and leadership to resolve issues, foster engagement, and maintain a positive work environment.
- Cross-Functional Collaboration: Partnered with clinical teams to align administrative processes with patient care, enhancing service delivery and satisfaction.
Education
Certificate - Quality Customer Service
Rio Salado College
Remote06-2026
Leadership Program Certificate - undefined
UC Davis
11.2024
Skills
- Proactive challenge anticipation
- Simplifies complex processes
- Cross-functional collaboration
- Drives team engagement towards objectives
- Identifies and addresses process gaps
- Adaptable learner
- Promotes accountability in compliance and quality
- Proactive escalation resolution
- Empathetic communication
- Effective prioritization skills
- Highly effective communication
- Attention to detail
- Problem-solving skills
- Teamwork
- Assertiveness
- Call center experience
- Analytical thinking
- Multitasking and organization
- MS office
- Issue resolution
- Complaint handling
- Assignment delegation
- Effective leadership
- Coaching and mentoring
Timeline
Grievance Caseworker
The Cigna Group
11.2022 - Current
Patient Care Advocate
The Cigna Group / Express Scripts
08.2021 - 11.2022
Call Center Supervisor in Training
Amazon
02.2020 - 08.2021
Business Office Manager
Complete Home Care
02.2016 - 02.2020
Leadership Program Certificate - undefined
UC Davis
Certificate - Quality Customer Service
Rio Salado College