Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Sarah Nelson

Sioux Falls,SD

Summary

Dedicated professional with demonstrated strengths in customer service, medical eligibility and benefits, and quality review. Good at troubleshooting problems and building successful solutions. Excellent verbal and written communicator with strong background cultivating positive relationships and exceeding goals. Ready to take on challenges in a position using problem-solving and task prioritization skills to help the business, teams and customers succeed.

Overview

2026
2026
years of professional experience
1
1
Certification

Work History

Eligibility Senior Analyst

Express Scripts
07.2024 - Current
  • Analyzed data trends to help with file process.
  • Collaborated with cross-functional teams to enhance operational efficiency.
  • Nurtured strong working relationships with clients, ensuring their needs were met while exceeding expectations on deliverables.
  • Analyzed data to identify root causes of problems and recommend corrective actions.
  • Identified patterns and trends in large data sets and provided actionable insights.
  • Assisted with several projects to help clients get files in a timely manner.
  • Helped with password resets so clients can get files in.
  • Kept communication with clients/vendors for a smooth transition when systems were switched.


Insurance Customer Service Representative

Sanford Health
01.2018 - 02.2019
  • Took incoming calls regarding patient billing statements
  • Educated patients about the terms of contracts and payment requirements
  • Skilled in various insurance carries including but not limited to Medicaid, Medicare, Commercial and Worker's Comp insurance carriers
  • Inbound/Outbound calls specifically for Worker's Comp claims
    Experience with uploading medical records for various payers.

Quality Review and Audit Lead Representative

Accredo Health Group
06.2023 - 07.2024
  • Train new employees on quality audits policies and procedures.
  • Created and maintained detailed documentation of quality audits.
  • Ensured compliance with company policies and relevant regulations.
  • Identified errors while audit reviewing to provide feedback for improvement to clearance, ship clearance and auht/reauth representatives.
  • Answered questions and resolved concerns for audit representatives.
  • Maintained a positive working relationship with fellow staff and management.
  • Created slide shows for meetings for my supervisor.
  • Hosted audit meetings
  • Assisted with several audit projects

Eligibility Representative

Accredo Health Group
12/06/21 - 06.2023
  • Organized and hosted trainings in clearance.
  • Reviewed prescriptions that doctors sent in and cleared referrals under medical/pharmacy benefits to pharmacy.
  • Presented a procedure to representatives to help reduce the volume for that department.
  • Displayed strong telephone etiquette, effectively handling difficult calls.
  • Submitted dummy claims/test claims to make sure patient had active insurance and to make sure we had a paid claim. If needed called out to doctors office to obtain diagnosis code for medical claims.

Receptionist

A-OK Sanitary Service
06.2020 - 10.2021
  • Managed 'Rolloffs' and obtained payments from clients
  • Took inbound customer enrollment calls
  • Face to Face customer service engagement
  • Collaborated with peers and shared workloads
  • Assisted with business' social media page.

Education

Highschool Diploma -

Lincoln High School
05.2003

Skills

  • Quality Review of various documents and processes
  • Quick learner and strong ability to adapt to business and/or process changes
  • Experience with training peers in job roles
  • Skilled in 10-key and various forms of data entry/Intake processes
  • Expertise in various software platforms and system troubleshooting
  • Dedicated, passionate and motivated to make a positive impact
  • Audit Lead
  • Team Collaboration
  • Staff Training
  • Effective and Professional Communication

Certification

  • Actively enrolled in the coding program through U.S. Career Institute.

Timeline

Eligibility Senior Analyst

Express Scripts
07.2024 - Current

Quality Review and Audit Lead Representative

Accredo Health Group
06.2023 - 07.2024

Receptionist

A-OK Sanitary Service
06.2020 - 10.2021

Insurance Customer Service Representative

Sanford Health
01.2018 - 02.2019

Eligibility Representative

Accredo Health Group
12/06/21 - 06.2023

Highschool Diploma -

Lincoln High School

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