Carmen Smith Email & Phone Number

Houston, Texas, United States

Rancho Cordova, California, United States

Responsible for routine operations and people management functions within assigned operational area.Ability to motivate and develop individuals into strong team membersUse concepts and abilities to manage processes and operations, including procedural changes, inventories and workload management.Knowledge encompasses entire scope of concepts, practices and procedures within field of specializationGenerally, instructs, guides and oversees work of non-exempt staff with general direction from manager

Rancho Cordova, California, United States

Ensure adherence to all Board of Pharmacy, CMS and FDA standardsMonitor staff performance, listens to calls and provides feedback to agentsResponsible for the supervision of the Pharmacy technicians that are licensed pharmacy technicians who will conduct courteous and professional telephonic outreach to members, prescribers, and pharmacies related to medication adherencePartner with Pharmacy Leadership to create or update user processes and procedures with newly published guidelines and/or informationClearly inform and track team members on attendance guidelines, production standards, quality standards, and providing quality customer service within their operational unit

Domestic And International

Collaborate with SMEs to design, develop, evaluate, and adapt training materials for new hire consumptionExperience creating courseware for company wide useAddress individual, departmental, or cross functional business unit needs Deliver new and on-going employee training including soft skills, work flows and process training Ensure all learning objectives and learning curve performance metrics are achieved Conduct learning needs assessment and adjusts/adapts training delivery to suit all learning styles Assist with company wide implementation and training of new processing systems such as FacetsDesign and update desk level procedure workflows that adhere to regulatory agency guidelinesMentor new trainers to assist in transitioning into a trainer role Travel to vendor sites both stateside and internationally to provide training and training support Familiar with vendors learning style and culture which enables me to have strong working relationships

Act as a SME for claims adjustments, eligibility and benefits of Core, Premier, and Large Group plansEstablish and maintain production standards and measurement methods by aiding employees in interpreting information, understanding, and applying basic principles, policies and proceduresDevelop strategies and objectives directed toward meeting unit goals, handling and resolving Subscriber escalations, and exceeding Subscriber expectationsResolve incoming calls concerning members eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needsReview and analyzes member claims for accuracy as well as member education on how benefits are appliedComprehensive resolution of pharmacy calls concerning benefit coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements