Nyesha Shorter
Columbus
Summary
Eagerly seeking a role as a Customer Service Representative to leverage strong communication and problem-solving skills in enhancing customer satisfaction and support. Proven experience in managing inbound calls and resolving customer issues makes a great fit for delivering exceptional service and fostering positive client relationships.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Healthcare Screener
Resultscx
Remote
12.2024 - 01.2026
- Managed inbound calls from patients seeking insurance, ensuring efficient and clear communication.
- Conducted necessary questioning to gather essential information for insurance enrollment.
- Facilitated successful information transfer to enrollment specialists to streamline the enrollment process.
Insurance Verification Specialist
Remx
Remote
09.2023 - 03.2024
- Maintained adherence to Medicare, Medicaid, HIPAA, and private insurance regulations, improving authorization processes for patient care delivery.
- Handled communication with healthcare providers and insurers, ensuring efficient prior authorization and pre-certification procedures.
- Performed detailed medical reviews for prior authorization requests, following set criteria and protocols to verify patient eligibility accurately.
- Coordinated and managed the appeals process for denied authorizations, resulting in enhanced resolution rates and compliance with current healthcare provider and insurance standards.
Tier 1 Technical Support Representative
Vxi global solutions
Remote
04.2022 - 02.2024
- Conduct system diagnostics and troubleshooting to resolve hardware issues, ensuring optimal computer functionality.
- Execute daily system maintenance to ensure network reliability and performance.
- Collect and analyze user-reported data to diagnose and address hardware and software issues effectively.
- Implement minor repairs and upgrades to hardware and software, enhancing system performance and user satisfaction.
Pharmacy Support Specialists
Broadpath
Remote
04.2019 - 04.2022
- Responded to an average of 110 inbound/outbound calls daily regarding prescription claims, refill requests, and formulary exceptions.
- Trained in Medicare Part D, Medicaid, and commercial insurance plan guidelines.
- Processed prior auths and override requests in compliance with CMS guidelines, with 98% accuracy.
- Assisted pharmacists and techs with PBM portal issues, fax errors, and real-time eligibility validation.
- De-escalated frustrated callers, maintaining CSAT scores of 96%+ across 12 months.
- Coordinated with clinical pharmacists for therapeutic class support and urgent fill coordination.
- Utilized Avaya, EPIC, and Genesys Cloud to route calls and track queue status.
- Reduced claim follow-ups by 21% through better education on benefit verification tools.
Road side Assistance Customer Service
Hertz ( Vxi)
Remote
02.2017 - 02.2021
- Assisted customers by handling inbound calls, ensuring high-quality service and support during rental vehicle inquiries.
- Offered empathetic assistance to customers facing roadside emergencies, ensuring swift resolution and customer satisfaction.
- Coordinated tow services and arranged for replacement vehicles to mitigate customer inconvenience during vehicle breakdowns.
Education
High School Diploma -
Columbus Technical College
Columbus, GA 03.2011 - 05.2011
Skills
- Tracking and Documentation
- Teamwork and Collaboration
- Organizational Skills
- Issue and Resolution Tracking
- Technical Troubleshooting
- Interpersonal Skills
- Customer Service Support
- System Performance Assessments
- Hardware and Software Repair
- Defect Analysis and Resolution
- Analytical and Methodical
- Troubleshooting Network Issues
- Credit Card Payment Processing
- De-Escalation Techniques
- Efficient and Detail-Oriented
- Customer Account Management
- Call Documentation
- Order and Refund Processing
- Data Entry
- POS Systems and Ordering Platforms
- Calm and Professional Under Pressure
- Data Entry and Maintenance
- Issue and Complaint Resolution
- Inbound and Outbound Calling
- Conflict Mediation
- Process Optimization
- Office Equipment Proficiency
- System Implementation
- Senior Leadership Support
- Adaptive Team Player
- Call Center Operations
- Product Organization
- Customer Relations
Certification
Microsoft Certification
Timeline
Healthcare Screener
Resultscx
12.2024 - 01.2026
Insurance Verification Specialist
Remx
09.2023 - 03.2024
Tier 1 Technical Support Representative
Vxi global solutions
04.2022 - 02.2024
Pharmacy Support Specialists
Broadpath
04.2019 - 04.2022
Road side Assistance Customer Service
Hertz ( Vxi)
02.2017 - 02.2021
High School Diploma -
Columbus Technical College
03.2011 - 05.2011