Nicole Whitworth Email and Phone Number

➤ Researched member and provider appeals by using familiarity with claims processing and specific member benefit plans.➤ Followed UnitedHealthcare SOPs and communication with medical professionals and claims analysts to resolve disputes.➤ Communicated decisions and ensured understanding of the processes and policies used in the appeal decision process.➤ Assisted and acted as a knowledgeable and professional resource for fellow coordinators in the processing of appeals.➤ Reviewed, researched, investigated, and triaged claims that were denied to determine their correct status.➤ Drove the action and communication with appropriate parties regarding member appeals and grievance issues.➤ Researched and resolved written complaints submitted and ensured complaints have been categorized correctly.➤ Obtained additional documentation required for case review and evaluated to determine if clinician review was required.➤ Evaluated documentation and rendered decisions for non-clinical complaints using sound, fact-based decision making.➤ Completed necessary documentation of final appeals or grievance determination using appropriate templates.

➤ Animator, Artist – Dude Icarus, Indie City Games September Game Jam (http://www.switchbreak.net/dudeicarus) – 2010➤ Animation Lead/3D Artist – Grunt Work, Columbia College IAM Department – 2009 to 2010➤ Animator – The Collapse of Communism: Take 2, Hangover Productions & ArtCore Productions – 2009➤ Department Assistant – Northwestern University – 06/2003 to 08/2004

➤ Maintained and troubleshot school computers and for tutored students in animation, modeling, and department software.➤ Worked in the computer design laboratory to prepare learning environments, answer questions, and maintain workspaces.➤ Greeted and assisted students and staff participating in labs as well as answered and directed incoming phone calls.➤ Provided service excellence through courteous, informed, accessible, and professional engagement with students.➤ Collaborated with educators to support individual students needs across subject matter in smaller learning communities.➤ Walked each student through lessons to ensure their understanding of the right method to approach each question.➤ Assisted the director with training new hires on academic procedures and standards while collaborating with other tutors.

➤ Gathered and prepared data for over 2,000 customers for client's new customer service and distribution system.➤ Served as primary customer service rep. for hospitals in 7 states and supported program for blood-analysis reagents.➤ Onboarded, trained, and mentored several new hires on company procedures and use of in-house software.➤ Served as a technical liaison between participating agencies, customers, and vendors and provided technical support.➤ Ensured that data was complete, accurate, and entered in a timely manner to meet reporting deadlines.➤ Identified, analyzed, and interpreted complex data sets and performed in-depth data validation on collected information.➤ Maintained queries, reports, and data feeds for both internal and external users and provided information maintenance.➤ Assisted senior staff and members and providing cross training and technical assistance to other team members.➤ Translated complex ideas, issues, and observations into useful explanations and clear directions for the team.➤ Participated in group business meetings and data analysis activities to gather reporting and dashboard requirements.