Nyima Newton
Phoenix
Summary
Dynamic claims adjuster with proven success at Swift Transportation, leveraging critical thinking and advanced communication skills to negotiate favorable settlements and minimize financial risk. Recognized for enhancing customer satisfaction through effective problem-solving and meticulous claims investigation, consistently exceeding performance targets while maintaining compliance with regulatory standards.
Claims professional who values precision and efficiency in claims evaluation and resolution. Proven track record of managing high caseloads and settling claims accurately in compliance with company standards. Known for strong collaboration with team members and adaptability to changing needs, ensuring reliable performance and positive results.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Claim Adjuster
Swift Transportation
03.2020 - Current
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Prepared summaries of damage, payments, and policy coverage.
Prior Authorization Representative
CVS Caremark
06.2015 - 03.2020
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Verified eligibility and compliance with authorization requirements for service providers.
- Processed new medication and refill requests for authorization.
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
Optum RX Rep
United Healthcare
04.2017 - 10.2018
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Enhanced company reputation by providing exceptional customer service and support.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
- Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
Customer Service Representative/Sales Agent
Consumer Cellular
01.2015 - 06.2015
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Nike Athlete Associate
Concentrix
11.2014 - 12.2014
- Developed strong mental resilience through rigorous training sessions, enabling peak performance during competitions.
- Adapted quickly to changes in competition schedules or environments, demonstrating mental agility and composure under pressure.
- Balanced academic commitments with athletic pursuits, maintaining a high GPA while excelling in sports activities.
- Demonstrated strong leadership skills as a team captain, motivating teammates and fostering a supportive environment.
- Displayed excellent sportsmanship, earning the respect of coaches, teammates, opponents, and officials alike.
- Contributed to the success of the team by consistently meeting or exceeding personal goals and expectations.
Nesting Coach
Stream Global Services Inc.
12.2012 - 11.2014
- Promoted sportsmanship values among athletes, fostering a positive competitive atmosphere within the team environment.
- Boosted player confidence through personalized training sessions and continuous feedback.
- Collaborated with other coaches to share best practices, techniques, and insights for overall program improvement.
- Developed strong relationships with players'' families to encourage support and involvement in their athletic growth.
- Enhanced team performance by developing and implementing effective coaching strategies.
- Managed practice schedules, ensuring efficient use of time and resources for optimal results.
Education
No Degree -
Maricopa Community Colleges, Gateway Community College
Phoenix, AZNo Degree - Customer Service Certifcate
Maricopa Community Colleges, Rio Salado Community College
Tempe, AZ08-2015
High School Diploma -
Lajoya Community High School
Avondale, AZ12-2011
Skills
- Critical thinking
- Claims investigation
- Active listening
- Highly motivated
- Team collaboration
- Claims processing
- Advanced oral and written communication skills
- Decision-making
- Advanced computer skills
- Innovation and creativity
- Customer service
- Problem-solving
- Attention to detail
Certification
- LiveChat Expert LiveChat, Inc.
Languages
English
Full Professional
Timeline
Claim Adjuster
Swift Transportation
03.2020 - Current
Optum RX Rep
United Healthcare
04.2017 - 10.2018
Prior Authorization Representative
CVS Caremark
06.2015 - 03.2020
Customer Service Representative/Sales Agent
Consumer Cellular
01.2015 - 06.2015
Nike Athlete Associate
Concentrix
11.2014 - 12.2014
Nesting Coach
Stream Global Services Inc.
12.2012 - 11.2014
No Degree -
Maricopa Community Colleges, Gateway Community College
No Degree - Customer Service Certifcate
Maricopa Community Colleges, Rio Salado Community College
High School Diploma -
Lajoya Community High School
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