Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nikki Sellers

Clanton,AL

Summary

Dynamic Health Plan Specialist with expertise in claims processing and insurance verification at Medica. Proven track record in resolving complex customer issues and enhancing operational efficiencies. Strong analytical thinking and exceptional interpersonal communication skills drive successful outcomes in customer engagement and policy interpretation. Committed to delivering high-quality service and compliance in healthcare.

Overview

14
14
years of professional experience

Work History

Health Plan Specialist Claims Processor Billing Sp

Medica
Clanton
10.2023 - Current
  • Managed the daily workflow of members' enrollment applications and insurance claims.
  • Ensured accuracy of data maintained in system databases related to health plan benefits.
  • Researched and resolved complex customer service issues in a timely manner.
  • Interpreted policy language to determine coverage eligibility for various services provided by healthcare providers.
  • Processed incoming requests for changes in benefit coverage as per established procedures.
  • Documented all customer interactions according to established protocols.
  • Reviewed and analyzed health care claims to identify discrepancies, errors or frauds.
  • Advised customers on their rights under existing healthcare plans.
  • Participated in meetings with external stakeholders such as vendors, brokers, to discuss business needs related to health plans.
  • Assisted in the development of short-term strategies for improving operational efficiencies within the department.
  • Maintained up-to-date knowledge of state and federal laws governing health plans.
  • Developed and implemented procedures for processing of medical claims and enrollments.
  • Conducted data entry activities for accurate maintenance of patient records.
  • Resolved customer complaints in a timely manner while maintaining high levels of professionalism.
  • Provided technical assistance to providers regarding claim status, billing issues, contractual requirements and other related inquiries.
  • Calculated premiums and established payment methods.
  • Participated in weekly training sessions to improve product knowledge and enhance company growth.

Server Shift Leader

The Front Porch Grill
Millbrook, AL
04.2019 - 03.2020
  • Created positive guest experience by listening to guest needs and recommending options to meet requests.
  • Managed tables throughout dining room to execute service at highest level.
  • Maintained thorough knowledge of menu to describe dining options.
  • Directed and assisted in general dining room cleaning and sanitation.
  • Trained and acclimated new servers to restaurant's culture and operations.
  • Cleared dishes from tables during and after meal service to maintain clean dining area.
  • Held performance reviews to identify and correct areas needing improvement.
  • Leveraged proper serving etiquette to promote inviting dining atmosphere.
  • Welcomed guests with personable attitude and brought beverage orders while reviewing menu options.
  • Greeted customers, answered questions and recommended specials to increase profits.
  • Checked on guests to verify satisfaction with meals and suggested additional items to increase restaurant sales.
  • Maintained knowledge of menu items, garnishes, ingredients and preparation methods to assist guests with menu selection.
  • Calculated charges, issued table checks and collected payments from customers.
  • Communicated with hosts, bussers and kitchen staff to prepare for and serve customers.
  • Rolled silverware and set up food stations and dining areas to prepare for next shift or large parties.
  • Prepared salads, appetizers and garnishes to assist kitchen staff.
  • Presented menus to patrons, answered questions about menu items and made recommendations.
  • Provided exceptional service to high volume of daily customers.

Shift Manager

McDonald’s
Millbrook, AL
10.2015 - 05.2017
  • Upheld company standards and compliance requirements for operations.
  • Positioned skilled staff in key areas throughout shift to optimize department productivity.
  • Managed schedules, accepted time off requests and maintained coverage for shifts.
  • Enhanced operations and boosted productivity through employee training, coaching and assignments.
  • Reinforced rules to promote superior employee performance.
  • Directed employees through daily routines.
  • Handled customer complaints, questions and inquiries.
  • Managed cash positions and made bank deposits.
  • Counted out cash drawers at end of each shift and logged profits into computer system.
  • Managed inventory and ordered new products when inventory was running low.

Customer Service Representative

ASK Telemarketing
Montgomery, AL
04.2011 - 02.2015
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
  • Educated customers on special pricing opportunities and company offerings.
  • Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
  • Assisted customers with making payments or establishing payment plans to bring accounts current.
  • Fielded customer complaints and queries, fast-tracking them for problem resolution.
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
  • Audited customer account information to identify issues and develop solutions.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
  • Consulted with customers to resolve service and billing issues.
  • Escalated customer concerns, issues and requirements to supervisors for immediate rectification.
  • Answered incoming telephone calls to provide store, products and services information.
  • Made outbound calls to obtain account information.
  • Explained benefits, features and recommendations to maximize client retention.
  • Upsold products and services to address customer needs and maximize sales.
  • Answered inbound calls, chats and emails to facilitate customer service.
  • Reviewed account and service histories to identify trends and resolve issues.
  • Set up and activated customer accounts.
  • Improved customer service wait times to mitigate complaints.
  • Answered customer questions and addressed concerns resulting in reduction in customer complaints.
  • Relayed customer feedback to cross-functional teams to improve products and services.
  • Upheld privacy and security requirements for customer information.
  • Exceeded company productivity standards on consistent basis.

Education

Associate of Science - Surgical Technology

Virginia College - Montgomery Campus
Montgomery, AL
07.2016

Skills

  • Expertise in menu item details
  • Sanitation practices
  • Table bussing
  • Verbal and written communication
  • Relationship management
  • Service prioritization
  • Quality control
  • Food safety understanding
  • Microsoft Office
  • Training abilities
  • Insurance Verification
  • Policy Knowledge
  • Claims Processing
  • HIPAA Compliance
  • Healthcare knowledge
  • Negotiation abilities
  • Policy analysis
  • Policyholder Communication
  • Account Management
  • Customer Engagement
  • Customer Billing
  • Asset Protection
  • Multitasking
  • Analytical Thinking
  • Time management abilities
  • Relationship Building
  • Insurance Claim Regulations
  • Organizational Skills
  • Insurance Coverage Verification
  • Customer Complaint Resolution
  • Interpersonal Communication
  • Premium Calculations
  • Decision-Making
  • Healthcare Common Procedure Coding System HCPCS
  • Claims Information Gathering
  • Team building
  • Billing Inquiries
  • Insurance Practices
  • Problem-solving abilities
  • Self Motivation
  • Requirements Reviews
  • Form Completion and Submission
  • Problem-Solving
  • Attention to Detail
  • Critical Thinking
  • Customer Referrals
  • Policy adjustment knowledge
  • Insurance Eligibility
  • Time Management
  • Customer Account Review
  • Professionalism
  • Team Collaboration
  • CRM Software
  • Call Center Customer Service
  • Persuasive Negotiation
  • Compliance management
  • Customer relationship management
  • Regulatory knowledge
  • Problem solving
  • Effective communication
  • Attention to detail
  • Benefit administration
  • Data analysis
  • Policy interpretation
  • Claims processing
  • Time management
  • Team collaboration
  • Microsoft office
  • Insurance verification
  • Healthcare
  • HIPAA compliance
  • Cold calling

Timeline

Health Plan Specialist Claims Processor Billing Sp

Medica
10.2023 - Current

Server Shift Leader

The Front Porch Grill
04.2019 - 03.2020

Shift Manager

McDonald’s
10.2015 - 05.2017

Customer Service Representative

ASK Telemarketing
04.2011 - 02.2015

Associate of Science - Surgical Technology

Virginia College - Montgomery Campus

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