NIKI MITCHELL
Houston,Texas
Summary
Type 55-65 wpm
Brings proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs. Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires and providing customized solutions to build loyalty. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Experienced Customer Service Representative with 13 plus years of experience working in busy, fast-paced call center. Committed to providing prompt, quick and accurate service to large volume of incoming calls. Well-qualified Customer Service - Dispatcher with proven success in improving operations and solving problems. Highly proficient in building lasting relationships with key decision makers, customers and team members to further company goals. Ready to leverage training and experience to take on new professional challenges.
Overview
11
11
years of professional experience
Work History
Eligibility Specialist
CareMetx
12.2023 - 02.2024
- Reduced errors in eligibility determinations by maintaining thorough knowledge of program guidelines and regulations.
- Conducted extensive research on available resources to connect clients with appropriate community services and support networks.
- Resolved discrepancies with client applications to verify eligibility.
- Kept current on industry trends and best practices through ongoing professional development activities, ensuring continued excellence in service delivery.
- Improved customer service experience for applicants, providing clear explanations of eligibility requirements and addressing concerns promptly.
- Managed high caseloads efficiently, prioritizing tasks effectively and utilizing time-management skills to meet deadlines consistently.
Customer Service Representative
WEX HEALTH
02.2023 - 02.2024
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company''s database.
- Enhanced customer satisfaction by promptly addressing inquiries and resolving issues in a professional manner.
- Conducted annual open enrollment sessions to ensure employees were well-informed about their options and plan changes.
- Assisted in resolving complex benefits issues, leading to increased employee satisfaction and retention rates.
Dispatcher-Patient Courier
Metro Rehab Clinic
02.2021 - 10.2022
- Drove safely at all times to avoid accidents and harm.
- Greeted patients, delivered them safely to and from clinic, labs and blood work appointments..
- Followed company policies and procedures during shift.
- Operated vehicle safely in highly congested areas with no traffic violations.
- Directed dispatching, routing and tracking of 13-15 fleet vehicles.
- Evaluated and adjusted over several routes based on daily needs, available workers, traffic hazards and weather conditions.
- Facilitated communications between customers and field personnel to answer questions or resolve concerns.
- Responded to over several daily caller requests with information about assistance and timeframes.
- Sent out drivers to assist several hourly callers based on locations, needs and worker availability
Care Manager Associate-Engagement Specialist
Aetna
07.2018 - 12.2020
- Responsible for outreach
to and enrollment of eligible members. - Demonstrates highly energetic blend of sales person, health care
navigator and health plan customer support representative. - Responsible for direct member outreach and engagement, facilitating case
assignment, and connecting identified Commercial and Medicare
Advantage members to care management services. - Effectively meets daily metrics with speed, accuracy, and positive at
with focus on number of outbound dials and effectiveness in enrolling
members into Aetna Community Care. - Accurately and consistently documents each call in members electronic
record, thoroughly completing required actions with high level of detail
to ensure we meet our compliance requirements. - Protects confidentiality of members during enrollment calls,
appropriately managing difficult or emotional members situation,
responding promptly to members needs, and demonstrating empathy and
sense of urgency when appropriate.
Office Manager
Spade Chiropractic LLC
05.2014 - 03.2018
- Developed standard operating procedures for all administrative employees.
- Arranged corporate and office conferences for company employees and guests.
- Prepared meeting materials and took clear notes to distribute to stakeholders.
- Maintained computer and physical filing systems.
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving.
- Optimized organizational systems for payment collections, AP/AR, deposits and recordkeeping.
- Provided clerical support to company employees, including copying,
faxing and file management. - Verified and created claim Numbers by communicating with various
insurance companies. - Interacted with providers and other medical professionals regarding
billing and documentation policies, procedures and regulations. - Professionally and courteously verified appointment times with
patients.
Sr Customer Service Representatitve
Aetna
11.2013 - 04.2014
- Provides targeted, personalized service based on a holistic view of the
member, benefits, health information, and through engagement. - Handles customer service inquiries and problems via telephone,
internet, web-chat or written correspondence. - Engages, consults and educates members by delivering individualized
programs based upon the members unique needs and preferences. - Utilizes resources to assist customers in understanding components of
the Aetna products including claims, accumulators, usage and
balances, and cost sharing. - Worked to ensure customer satisfaction and retention while effectively
documenting all contacts with our members. - Referred unresolved customer grievances to designated departments
for further investigation. - Provided Summary Of Benefits to different Physicians and Pharmacy's
and members. - Handled member reimbursements and Etf Payments of all kinds.
- Transferred members to the correct departments.
Customer Service Specialist
General Dynamics
09.2012 - 04.2013
- Effectively managed a high-volume of inbound and outbound
customer calls. - Provided knowledgeable response to inquiries (phone, web chat,
e-mail, TTY , fax correspondence) in a courteous and professional
manner. - Provides targeted, personalized service based on a holistic view of the
member, benefits, health information, and through engagement. - Enrolled members in the plan of their choice.
- Educated members on the different plans by doing side by side comparison.
Education
High School Diploma -
JEFFERSON HIGH SCHOOL
HOUSTON, TEXAS06.1992
Skills
- Customer Service
- Multitasking
- Active Listening
- System Documentation
- Benefits Explanation
- Microsoft Office Proficiency
- Healthcare Benefits
- Dispatching Procedures
Timeline
Eligibility Specialist
CareMetx
12.2023 - 02.2024
Customer Service Representative
WEX HEALTH
02.2023 - 02.2024
Dispatcher-Patient Courier
Metro Rehab Clinic
02.2021 - 10.2022
Care Manager Associate-Engagement Specialist
Aetna
07.2018 - 12.2020
Office Manager
Spade Chiropractic LLC
05.2014 - 03.2018
Sr Customer Service Representatitve
Aetna
11.2013 - 04.2014
Customer Service Specialist
General Dynamics
09.2012 - 04.2013
High School Diploma -
JEFFERSON HIGH SCHOOL
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