- Experienced Leader in the pharmacy benefits management setting.
- Two years experience as a supervisor with experience in training, managing and motivating staff.
- Ability to engage in multiple projects with tight deadlines.
- Detail oriented, proficient in multi - tasking, problem solving and accustomed to a fast paced environment.
- A team player but also works well independently.
Computer literate in: MS Word, Excel and Power Point.
Client Benefit Analyst
- Analyze client benefit requests to determine client intent for benefit plan design
- Research issues and recommend alternative solutions based on client need
- Provide consultation to clients and internal partners during new business implementation
- Coordinate with internal partners to ensure the appropriate documentation is received
- Responsible for meeting or exceeding turnaround time and quality standards
- Review of prior authorization and appeals for Confidential enrollees
- Supervisor of 34 technicians performing reviews for coverage determinations and appeals
- Ensure policies and procedures as well as CMS regulations are followed
- Project management with multiple teams across multiple site locations
- Conduct audits and coaching for quality and assurance
- Develop new policies and procedures to increase efficiency
- Daily troubleshooting of complex issues
- Review of prior authorization and coverage determinations for Confidential and commercial enrollees
- Provides support to the Appeals Department in meeting clients' expectations regarding efficiency, service levels, privacy maintenance and quality of decision-making
- Trained pharmacists and technicians
- Create process workflows and work instructions
Senior Customer Service Specialist
- Handle complex or escalated calls from customers regarding online accounts
- Perform routine account-related transactions such as opening new accounts, completing the online account set-up process, account maintenance and completing wire transfers
Customer Service Representative
- Provide quotes for personal property and personal auto insurance
- Collect and record necessary customer information
- Respond to customer questions and concerns
- Input, maintain and follow-up on clients and prospected clients insurance needs
- Assist clients in reporting claims
Operations Service Technician
- Supervise workflow and daily activities for RI personal property and personal auto team
- Train new employees for RI personal property and personal auto team
- Pre-underwrite and code new business and endorsements for RI personal property and personal auto team
- Assist underwriters in evaluating new business personal property and liability risks for acceptance or denial in accordance with company underwriting guidelines and philosophies