Carmen Sams Email and Phone Number

Provide timely and accurate responses to inbound calls and emails from patients regarding their self-injectable medicationsIdentify and triage customer escalations through resolution, including collaboration with other departments to ensure compliant solutionsReceive up to 40 inbound calls a day from doctor offices, pharmacists, patients and caregiversAchieved a 98% customer satisfaction rate based on post-interaction surveysPlaced within the top 5% of the overall team’s metricsEducate callers and create awareness regarding medication safetyTrain patients and caregivers on how to administer their injectable medicationsCreate vouchers for product replacementPerform assessments, create, document and assign cases regarding adverse events, patient safety issues and technical complaints

Successful management of 62 key client accounts with respect to FSA, HRA, Commuter Benefits, COBRAImplement changes based on feedback, resulting in a 15% increase in client loyaltyManaged a high volume of customer medical claims ensuring a 98% accuracy rate for quality assurance and timely resolutionFront-line support for client HR departments in researching and solving problems such as: employee eligibility, claim payment issues and member cardsReceived up to 35 inbound calls a day from customers, clients and sales representativesAchieved a 97% enrollment rate, in having client’s open enrollments completed by deadline datesResponded to customer inquiries regarding claim status, coverage details, documentation requirements and providing excellent customer serviceCreated and emailed excel Flex Reports to clients on a weekly basisHosted virtual training sessions and Power Point presentations for client contactsProcessed, audited, and reconciled monthly benefit reports, premium payments and other financial transactionsApplied appropriate credits and refunds to client and members accountsProcessed new hire benefit enrollments, life event changes, and terminations Processed and administered COBRA paperwork and payments as assigned. Keyed and mailed required notices to eligible associates and their family members as appropriate

Received up to 55 inbound phone calls from individuals seeking social services and community-based assistance (relocation, grief, homelessness, eviction, employment and education resources)Conducted comprehensive assessments with individuals to identify appropriate referrals based on clients' strengths, needs, and goalsMonitored program outcomes, collected data, and prepared reports for program evaluationsPlace outbound follow-up calls to members and nonmembers to ensure that the resources provided were able to assist with their needsCoordinated with local agencies and community partners to expand the range of available services and resourcesProvided crisis intervention and emotional support to individuals and families facing challenging circumstancesIdentify and communicate referral gaps within the programs systems to upper managementConducted regular program audits to assess effectiveness and identify areas for improvement

Obtained and verified insurance information, including the prior authorization process, copay assistance and coordination of benefitsImplemented a mentorship program, enhancing the skill set and confidence of team members.Oversaw a team of 8, achieving a 20% improvement in overall team productivityHandled inbound calls from patients, physician offices, and or insurance companiesAssisted with leading a high-performing care manager team in achieving a 10% improvement in client satisfaction scores.Trained new associates and provided the guidance necessary to meet program metrics by, real-time feedback which was essential in meeting the client’s goals and expectationsObtained benefit verifications with multiple insurance payers for physician-administered medicationsGathered benefits for medical, hospital and pharmacy servicesFollowed up on the submission of prior authorizations and pre-determinations cases, also obtained the requirements for submitting those requests, paying close attention to detail and accuracy with provided information

Subject matter expert with the major commercial insurance payers, Medicaid and Medicare plans Verified patient’s medical and pharmacy insurance benefits for specialty medicationProficient with CPT/ICD 10 codesCollaborated with insurance companies and other healthcare professionals to resolve complex issues, achieving a 30% improvement in claims resolution timesAssisted regular training sessions for benefit verification specialist, resulting in a 20% improvement in technical proficiencyCollected and reviewed all patient insurance information needed to complete the enrollment, benefit verifications, appeal processes and REMSIdentified and coordinated patient resources as it pertains to reimbursement, such as copay cards, third party assistance programs, and manufacturer assistance programsObtained benefit verifications for physician administered medications, hospital, and pharmacy servicesObtained prior authorization, pre-determination and appeal requirements for servicesPeer reviewed and coached new team members, advising of SOPs and best practicesIndependently analyzed, reports, and communicated any reimbursement trends/delays Provided technical support assistance by providing password resets, identified, analyzed user requirementsDocumented and tracked denied claimsAssisted regular training sessions for benefit verification specialist, resulting in a 20% improvement in technical proficiency