Summary
Overview
Work History
Education
Skills
Timeline
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Nictosha Gaines

Houston,Texas

Summary

Dedicated hard-working individual looking to experience the role you are offering. I have 11 years of working experience in customer service and support. I am proud of helping and assisting others as well as multi-tasking. I am an expert in computers and a speedy typer. I am reliable at all times. I have no problem learning new roles and training. Hope to hear back

Overview

7
7
years of professional experience

Work History

CUSTOMER SERVICE ADVOCATE

United Health Care
10.2022 - Current
  • Researched assistance requested and offered accurate information to resolve issues and respond to inquiries
  • Answered inbound calls to greet and assist customers with various needs and questions
  • Resolved customer inquiries, complaints, and issues providing insightful solutions
  • Documented detailed notes in CRM system to track customer interactions
  • Offered products and services to meet customers' needs and goals
  • Met and exceeded daily service quality and performance goals
  • Researched claims and authorizations
  • Contacted doctors offices, pharmacies, and dental offices
  • Ordered equipment for members in need
  • Discussed benefits of plan member enrolled in
  • Ordered new ID cards
  • Discussed denials of claims, authorizations, and appeals
  • Filed appeals, grievances, and complaints
  • Contacted transportation for members on Medicaid benefits
  • Assigned providers for members
  • Updated member information.
  • Examined claims forms and other records to determine insurance coverage.
  • Reviewed medical, vision and pharmacy claims.
  • Reviewed prior authorizations for procedures.
  • Navigated through multiple systems to research, resolve and process work assigned.


CLERK II

The State Of Texas Health And Human Services
06.2019 - 10.2022
  • Collect confidential information from clients
  • Created reports and developed improvements and enhancements to automate records and file systems
  • Received and routed business correspondence to correct departments and staff members
  • Kept office supplies well organized and sufficiently stocked, placing orders promptly to replenish materials before depleted
  • Entered personal data using TIERS, data broker, state portal, and EWMS along with following procedures to keep information private
  • Managed multiple projects simultaneously using organizational and analytical skills
  • Kept track of log in activity for all visitors and staff
  • Steady use of fax, copy, and scanning machinery
  • Complete reports for clients and staff over the state of Texas
  • Answered desk and office phone with appropriate professional greeting
  • Use of Microsoft Teams, Skype, and Outlook
  • Maintain awesome energy and relations with coworkers and clients.
  • Reviewed medical and dental state claims.
  • Investigated SNAP EBT claims for reimbursement.
  • Followed up with customers on unresolved issues.
  • Coordinated with healthcare providers to verify treatment plans and expenses.
  • Negotiated settlements with claimants, achieving favorable outcomes for both parties.
  • Followed state medicaid processing procedure for claims and settlements.

CASE AIDE

Harris County
11.2021 - 06.2022
  • Maintained communication between youth, family members, and case managers to complete the reunification process
  • Promoted and encouraged positive interactions and helped maintain healthy relationships among participants
  • Inserted community service hours using data from time sheets sent by contracted companies
  • Checked in adult probation clients for visits with probation officers
  • Administered education tests for adults with no diploma
  • Called clients to schedule classes for drug and alcohol, theft, and sex offenses
  • Sent files to court for community services
  • Verified community service hours
  • Notated account of offenders for call-ins
  • Created PowerPoints for classes
  • Administered information needed for classes
  • Added education information in databases
  • Filed court documents and probation documents in appropriate filing cabinet
  • Shred confidential unwanted information.

CUSTOMER SERVICE ASSOCIATE

Xerox
06.2017 - 10.2018
  • Achieved high satisfaction rating through proactive one-call resolutions of customer issues
  • Provided primary customer support to internal and external customers
  • Used company database to retrieve customer prescriptions for refills and fillings
  • Followed all HIPAA guidelines
  • Maintained accurate and current customer account data with manual forms processing and digital information updates
  • Helped a large volume of customers every day with a positive attitude and focus on customer satisfaction
  • Informed customers about special promotions and provided detailed information for various products
  • Offered advice and assistance to customers, paying attention to special needs or wants
  • Answered a constant flow of customer calls with minimal wait times.

Education

HIGH SCHOOL DIPLOMA -

Knowledge First Academy
Missouri City, TX

ASSOCIATE OF APPLIED SCIENCE - LAW

Houston Community College
Houston, Texas
05.2025

Skills

  • Document Typing and Formatting
  • Government Forms
  • Office Machine Operation
  • Staff Training
  • Equipment Troubleshooting
  • Record Sorting and Filing
  • Self-Motivated
  • Data Entry and 10-Key
  • Verbal and Written Communication
  • Mail Sorting and Routing
  • Outgoing Mail Preparation
  • Outlook
  • Microsoft
  • Insurance Claims Review
  • Data Analysis
  • Decision-Making
  • Coverage Determination
  • Policy understanding
  • Documentation Review
  • File Management
  • Claims Processing
  • Medicaid knowledge
  • Records Management
  • Documentation processing
  • Denied claims identification
  • Insurance Coverage Verification
  • Excellent administrative abilities
  • Data Entry Software
  • Prior authorization processing
  • Customer Service
  • Problem-solving abilities
  • Critical Thinking
  • Customer Relations
  • Problem Resolution
  • Microsoft Outlook
  • Call Management
  • Scheduling
  • Follow-up skills
  • Appointment Scheduling
  • Administrative Support
  • De-Escalation Techniques

Timeline

CUSTOMER SERVICE ADVOCATE

United Health Care
10.2022 - Current

CASE AIDE

Harris County
11.2021 - 06.2022

CLERK II

The State Of Texas Health And Human Services
06.2019 - 10.2022

CUSTOMER SERVICE ASSOCIATE

Xerox
06.2017 - 10.2018

HIGH SCHOOL DIPLOMA -

Knowledge First Academy

ASSOCIATE OF APPLIED SCIENCE - LAW

Houston Community College

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Nictosha Gaines