Summary
Overview
Work History
Education
Skills
Certification
Affiliations
Languages
References
Timeline
Generic

Nissa Duarte

Tucson,AZ

Summary

Results-driven Client Service Analyst known for high productivity and efficient task completion. Specialize in client relationship management, data analysis, and problem resolution strategies. Excel in communication, teamwork, and adaptability to ensure optimal service delivery and client satisfaction. Committed to leveraging these skills to foster positive outcomes in fast-paced environments.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Client Service Analyst

OptumRx
01.2019 - Current
  • Facilitated effective communication between clients, account management, and departments to support organizational goals.
  • Served as daily client account liaison handling operational matters such as claim inquiries and eligibility updates.
  • Provided strategic support through regular client meetings and member activities such as benefit fairs and open enrollment meetings
  • Monitored daily plan activities and provided input on operational trends, managed RDS/EGWP communications, HIPAA matters, and industry updates

Complaint to Medicare Coordinator

UnitedHealth Group
03.2017 - 01.2019
  • Collaborated with teams in evaluating, investigating, and settling various appeals and grievances.
  • Resolved complicated insurance and provider complaints submitted by consumers and physicians.
  • Executed utilization of multiple claim research platforms like COSMOS, CPW, GPS, RX Claims and Navigator.

Service Account Manager Associate / Government Service Support Lead

OptumRx
05.2015 - 03.2017
  • Managed resolution of advanced service challenges at the group level while supporting operational processes.
  • Handled escalated issues by serving as a point of contact, ensuring timely resolutions.
  • Communicated resolutions effectively after analyzing claims and concerns.
  • Performed weekly test calls assessing advocate knowledge to enhance service quality.
  • Updated tools and resources to enhance operational efficiency for member service agents.

Customer Service Lead

OptumRx
09.2012 - 05.2015
  • Provided internal help desk support for call center agents, assisting with procedural and process problems
  • Conducted new hire interviews for the customer service department and coordinated training for lead assist
  • Joined project teams for new development initiatives, such as the image viewer program
  • Assisted supervisors with daily reporting and coordination of floor support during management meetings
  • Acted as the point of contact for a team of 14 when the supervisor was out and served as interim supervisor for teams of 16 or more, handling reporting and coaching as needed
  • Managed supervisor escalation calls and callback requests for the production floor

Education

High School Diploma -

Tucson Accelerated High School
Tucson, AZ
05-2005

Skills

  • AS-400/Rx Claims Analysis
  • Navigator
  • IRIS
  • Advocate Central
  • Salesforce
  • Account management
  • Complaint handling

Certification

Certified Pharmacy Technician

Affiliations

  • Regular volunteer in the community for senior citizens
  • Regularly service as maintenance volunteer for local congregation of Worship

Languages

Spanish
Professional

References

References available upon request.

Timeline

Client Service Analyst

OptumRx
01.2019 - Current

Complaint to Medicare Coordinator

UnitedHealth Group
03.2017 - 01.2019

Service Account Manager Associate / Government Service Support Lead

OptumRx
05.2015 - 03.2017

Customer Service Lead

OptumRx
09.2012 - 05.2015

High School Diploma -

Tucson Accelerated High School

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Nissa Duarte