NICOLE O’NEAL
Sacramento,CA
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Seeking long-term, part-time position that offers a remote and flexible schedule utilizing data entry claims processing experience, excellent time management and problem-solving skills.
Overview
10
10
years of professional experience
Work History
Personnel Specialist
California Exposition & State Fair
12.2023 - Current
- Initiated and maintained personnel and employee-related files and records and established archives to support internal audits.
- Created and implemented employee benefit education plan and answered benefit-related questions to help employees select options.
- Researched options and mandates to enable proper implementation of personnel procedures.
- Oversaw electronic processing to deliver appropriate paychecks and benefits to employees.
- Liaised with broker to research and recommend employee health, dental, life and short-term and long-term disability benefits options to facilitate open enrollment.
- Administered employee health, dental, FSA and disability benefits and worked with broker to research and recommend options and oversee open enrollment.
- Developed and implemented onboarding and orientation programs for new employees.
- Improved organizational filing systems for confidential employee records, resulting in improved accessibility and efficiency.
- Collaborated with managers to identify and address employee relations issues.
- Administered employee benefits programs and assisted with open enrollment.
Human Services Specialist II
County Of Sacramento, Department Of Human Assistance
12.2013 - 12.2023
- Handled crisis situations by authorizing cash aid, food stamps and Medicaid benefits within specific guidelines or made appropriate referrals to other staff and community resources for immediate services and assistance
- Analyzed changes in financial, employment, family, and personal information to determine and authorize continuing eligibility for multiple aid programs
- Input necessary information into automated systems; organized caseload and took required action with specific time limits established by regulation and local policy
- Identified suspected fraud and referred to investigation department
- Maintained heavy caseload of approximately 30 cases by utilizing effective time management and organizational skills
- Processed applications and followed strict procedures to keep sensitive data confidential
- Answered high volume of calls and provided assistance through effective listening and question response skills
- Participated in trainings and seminars to improve skills set and knowledge
- Adhered to strict client confidentiality laws and site-specific procedures to uphold privacy and provide best experience possible
- Described procedures, requirements and benefits to clients and interested parties
- Prepared documents for review and completion by service applicants, supporting completion and responding to questions
- Interviewed applicants for services and supported application completion as necessary
- Acted as mandatory reporter of abuse
- Established positive relationships with aid recipients and assessed goals, working hard to address individual needs and tailor services to suit them
- Inputted information and obtained quantitative and qualitative data on client details to provide services requested
- Utilized complex client management systems, both digital and manual and maintained sensitive information in highly encrypted databases
- Assessed barriers, strengths and needs of each family and worked quickly to remediate
- Worked with others to manage numerous competing interests simultaneously and delegate accordingly to maximize productivity
Customer Service Representative
Kaiser Permanente - Member Services
- Provided membership eligibility, claim, payment, plan options, billing inquiries and benefit information (co-pays, deductibles, out of pocket maximums, etc.) to members
- Assisted members with navigation on Kaiser Permanente website and reset passwords
- Provided eligibility, claim, and benefit information to providers
- Processed payments for members
- Managed over 50 calls per day
- Handled customer inquiries and suggestions courteously and professionally
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
- Updated account information to maintain customer records
- Responded to customer requests for products, services, and company information
- Utilized customer service software to manage interactions and track customer satisfaction
- Tracked customer service cases and updated service software with customer information
- Developed customer service policies and procedures to meet and exceed industry service standards
- Met customer call guidelines for service levels, handle time and productivity
Intake Representative I
Health Net Federal Services, TriCARE
- Validated patient and medical provider information
- Determined whether patients are eligible to receive health care benefits under insurance program by determining patients’ status/eligibility, Primary Care Manager (doctor) type, and appropriate referral/authorization path
- Contacted medical provider offices by telephone, and makes confirmation calls to patients for all urgent requests
- Used sound judgment in making decisions in order to keep referral/authorization process moving forward in accordance with contractual timeliness standards
- Followed step-by-step instructions, including redirecting patients into provider network for care, as required by contractual standards
- Formulated brief sentences/paragraphs from referral/authorization orders and prepares correspondence in business letter format to provide clinical information to servicing providers
- Coded, searched, extracted, and interpreted information to ensure correct input
- Generated letters and reviews to validate that are assigned to correct providers/patients, and provider/patient demographics and reason(s) for services to be rendered are correct
- Met goals and produced results through tracking performance, improving work processes, and prioritizing work and tasks.
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information
Data Entry Specialist, Edit Clerk
Delta Dental Of California, DentiCal
- Processed Dental claims
- Verified and corrected operator errors
- Cleared edits for proper claims adjudication
- Completed data entry tasks with accuracy and efficiency
- Entered numerical data into databases with speed and accuracy using 10-key pad
- Communicated with supervisors and colleagues to process data quickly and resolve discrepancies
- Followed established procedures to enter and process data correctly
- Secured and protected data from unauthorized access by complying with security protocols
- Updated and maintained customer information, documents and records
- Followed data entry protocols, rules and regulations
- Conducted audits of existing data entry processes
- Utilized techniques for increasing data entry speed
- Used computer software to store and retrieve data
Education
CPC Certification - Medical Coding
AAPC
Sacramento, CA11.2019
Skills
- Excellent Organizational Skills
- Confidentiality and Security
- Document Processing
- Meticulous Attention to Detail
- Microsoft Office Suite Proficient
Timeline
Personnel Specialist
California Exposition & State Fair
12.2023 - Current
Human Services Specialist II
County Of Sacramento, Department Of Human Assistance
12.2013 - 12.2023
Customer Service Representative
Kaiser Permanente - Member Services
Intake Representative I
Health Net Federal Services, TriCARE
Data Entry Specialist, Edit Clerk
Delta Dental Of California, DentiCal
CPC Certification - Medical Coding
AAPC
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