• Analyze and prioritize workloads based on department inflows to meet company expectations. • Set expectations and hold team members accountable. Create an environment that promotes professionalism, engagement and inclusion. • Set expectations around productivity, quality, and other key metrics. • Act as a resource for internal and external customer; to include field personnel, medical professionals and other cross-functional areas to meet department’s goals. • Identify opportunities for improvement. Develop and execute action plans.• Monitor employees and department performance on key performance indicators. Communicates status appropriately. • Perform analysis and reporting for management as required. • Provide a high level of customer service in a competitive market. • Prioritize and execute based on customer and business urgency. • Conform to, support and enforce all Company policies and procedure. • Conduct monthly meetings as well as monthly individual meetings with employees. • Coach, develop, and counsel employees to effectively reach department goals.• Participate in any and all work activities as may be deemed suitable and assigned by management.

• Design and analyze complex reports and production strategies in order to satisfy business requirements, data analysis reports to management to take decisions.• Evaluation of business quality and performance, implement mechanisms of auditing.• Translate raw data into simple view and easy to understand (Excel, Power BI, etc).• Review daily the ROs in management review status. Provide feedback to team members in timely manner.• Support teammates with knowledge gaps, issues and others.• Partner to determine work priorities, assign responsibilities, support team projects and group work to ensure ongoing team success.• Collaborate with business stakeholders/leadership team to raise awareness of opportunities identified and suggested solutions for improvement.• Creating and provide ongoing trainings and team updates within customer service-related areas, such as customer inquiries, systems knowledge and/or order processing issues resolution• Participate in daily team meetings to discuss state of the business, planned activities, perceived barriers to achieving goals any system issues or suggestions for improvement.• Conduct Quality Audits and escalate • opportunities to the leadership team for review.• Implement process improvements and/or creative solutions to work processes and tools• Apply analytical skills to interpret data and identify trends is team or agent performance.• Support the team by taking escalated calls when needed.

• Responsible for collection of physician documents as required.• Prioritize work list to obtain production goals and minimize risk.• Review and analyze payer specific requirements and coverage criteria to determine required physician documentation.• Conduct review of documentation (Order forms, medical records, prescriptions, operative reports, history and physicals) as needed for physician identification.• Escalate to customer or field personnel as needed to aid in obtaining physician documentation required for billing. Including home health agencies, patients, hospital/facilities, physicians .• Meet production expectations which included total accounts worked, aged document percentages, and average per day documents collected.• Escalate to customer or field personnel as needed to aid in obtaining physician documentation required for billing. Including home health agencies, patients, hospital/facilities, physicians.

• Proactively engage potential members, effectively communicating the benefits and services offered by Humana Pharmacy to successfully enroll new members.• Vigilantly monitor and manage cases with delayed orders, ensuring they undergo normal processing and addressing any issues that may arise to ensure a seamless customer experience.• Efficiently handle prescription refills, providing accurate estimates for drug costs based on individual drug plan coverage. Facilitate the smooth transfer of prescriptions from local pharmacies to Humana Pharmacy.• Act as a liaison between patients and pharmacists, promptly addressing and communicating any medication-related issues to ensure a high standard of patient care.• Initiate contact with healthcare providers, including doctors, nurses, and specialists, to request necessary prescriptions for patients, demonstrating strong interpersonal and communication skills.• Navigate and communicate complex information related to drug plan coverage, federal requirements for drugs, and pharmacy procedures, ensuring clarity and understanding for both internal and external stakeholders.