Analyze and communicate complex information to over 600 assigned members and providers internal/external parties in understandable terms both verbally and written.Initiate outbound contact to members that has questions or concerns about plan, benefits, resources, claims, appeals, medications, and finding physicians/providers.Determine medical insurance for government sponsored Medicaid/ Medicare lines of business and confirm member eligibility and benefits.Participate in team… Show more Analyze and communicate complex information to over 600 assigned members and providers internal/external parties in understandable terms both verbally and written.Initiate outbound contact to members that has questions or concerns about plan, benefits, resources, claims, appeals, medications, and finding physicians/providers.Determine medical insurance for government sponsored Medicaid/ Medicare lines of business and confirm member eligibility and benefits.Participate in team meetings to discuss new ideas for improving the overall quality standards, meet established productivity, and schedule adherence.Developed strong customer relationships and loyalty through effective communication.Prioritized and organize tasks to meet compliance deadlines.Submit complaints/grievance categorized accordingly to fact-based decision making.Work on appeals due to denial of medications or medical/dental procedures.Complete necessary documentation to each member account. Show less

Successfully resolve inbound calls in a fast-paced environment to communicate specialty drug information to consumers, providers, and internal/external parties within the required timeframes verbal and written.Obtain additional documentation required for appeals case review for specialty drug coverage.Dedication to troubleshooting problems and utilize healthcare, medical, and pharmacy terminology to input, track, and report customer issues in required timeframe.Research and resolve… Show more Successfully resolve inbound calls in a fast-paced environment to communicate specialty drug information to consumers, providers, and internal/external parties within the required timeframes verbal and written.Obtain additional documentation required for appeals case review for specialty drug coverage.Dedication to troubleshooting problems and utilize healthcare, medical, and pharmacy terminology to input, track, and report customer issues in required timeframe.Research and resolve written complaints submitted by consumers and physicians/providers.Managed care and developed strategies to optimize patient outcomes through medication therapy management services.Monitored patient health status by conducting follow-up calls after each refill order was dispensed.Meet/exceed established operational metrics and customer expectations Show less

Utilize effective communication skills to explain product features, benefits and pricing information through telephone etiquette.Demonstrated ability to manage multiple tasks simultaneously while maintaining high levels of accuracy and attention to detail.Maintained accurate records of customer orders, payments and contact information using database software.Achieved monthly sales goals by actively engaging customers in conversations about their needs and interests.Trained new… Show more Utilize effective communication skills to explain product features, benefits and pricing information through telephone etiquette.Demonstrated ability to manage multiple tasks simultaneously while maintaining high levels of accuracy and attention to detail.Maintained accurate records of customer orders, payments and contact information using database software.Achieved monthly sales goals by actively engaging customers in conversations about their needs and interests.Trained new employees on best practices for handling customer service inquiries.Managed projects by creating and implementing sales strategies with purpose of growing the company customer experience outcome.Utilize Excel, SQL, querying and reporting methods to develop solutions to identify, analyze, and interpret trends or pattern in complex data sets.Uphold cooperative relationships and control expectations with internal personnel and external clients.Offer clients technical and/or application support within the designated product domain.Investigate and diagnose intermediate-level product and technical problems Show less