Worked remotely for the Payflex team, managing inbound calls from members regarding Healthcare Spending, Dependent Care, Health Reimbursement and Retiree Accounts. I addressed various member inquiries, including account balances, requests for new debit cards, handling overpayments, and assisting with the submission of claims and the required documentation. I also managed technical issues by submitting internal tickets for website or system malfunctions, ensuring smooth operation of daily processes. On occasion, I conducted outbound calls to members as needed for follow up on account concerns or to communicate progress and solutions promptly, fostering effective communication and member satisfaction.

• Handled inbound and outbound calls for benefits investigation. I was trained on the team that handles patients with Multiple Sclerosis. The purpose of my position was to contact insurance carriers, pharmacy benefit managers and infusion centers to obtain benefits information for our patients. I would contact the patient and relay the benefits information I obtained during the investigation and inquire with them if they have any questions or concerns regarding cost of their MS medication, or their copay, coinsurance or deductible. If the patient voices any concerns, I transfer them to the financial assistance department up in their permission to further discuss options of copay assist with the designated team members.

• Handled inbound and outbound calls for the specialty precertification department. Inbound calls consisted of members, facilities and providers’ offices calling in to check the status of a current precertification on file, and also to initiate a precertification request for a members’ specialty medication. The number of inbound calls varied from 5-45 depending on call volume. Inbound calls were also measured on a metrics system. Outbound calls consisted of contacting providers offices on behalf of members with precertification statuses to provide the approval information, or to advise them that some further information is required. Assured accounts were notated based on actions taken during the call. Received further training to enhance my knowledge and abilities within my job capacity. Certain tasks I was trained on are answering inbound calls and initiating precertifications via phone or fax, assess any clinical information necessary to review precertification based on our clinical policies prior to approval, search for received faxes and attach them to appropriate accounts, pend and submit cases that require review by medical director based on necessary criteria, and to submit them to the proper department, perform searches for eligibility, coordination of benefits and verification of benefits. Performed and completed numerous projects for supervisor between calls within a timely manner. Information used on a daily basis includes J-Codes, ICD-9 codes and service codes.Utilized several company-based operating systems, such as Aetna Strategic Desktop and Total Clinical View; also Plan Sponsor Tools, State Reference Guide, Oracle/Compass, Flashcode, Outlook, Microsoft Office, Microsoft Live Meeting along with other company based tools. Handled calls via Avaya phone.

• Was selected to be a part of the first class utilizing new computer software managing client accounts as part of the merger between Medco and Express Scripts. Managed high volume inbound calls for mail order prescription. Assisted clients in placing orders, checking on current order status or new prescription status, input or edit any new profile information, process payments and credits for orders. Checked eligibility and coverage details for clients such as any deductibles, Out Of Pocket costs, CAPs, and copays. Handled any necessary transferred or conference calls with specialized departments, certified pharmacists, doctor offices, translators, etc. Stayed up to date via company email on news and information within the team and the company that may affect myself or any clientele calling in during the workday. Followed up with any new information regarding medications that have been discontinued, recalled or changed by any prescribers and alert clients justly. Handled escalated calls and de-escalate to the best of my ability and customer service experience, and when necessary or as requested, transferred to dedicated supervisor. Assisted in training new hire and conversion classes on newly integrated computer system by partaking in overseeing On-Job Training classes and also by listening in to calls with colleagues and assisting with any inquiries or walkthroughs of procedures. Ensured daily stats, such as call handle time, hold time, call quality and adherence were maintained at the team’s designated level of excellence; more so while training others and assisting them with managing their stats at a preferred level as a new hire.

 Received training on proper phone etiquette for inbound calls. Was trained for the Your Spending Account team for approximately 3-4 weeks regarding clientele, phone procedures, logging information for calls, informational software and databases and customer service software usage. Trained on CSPro, LotusNotes, Navigator, workflow logging and other PESOC software. Worked with approximately 170 clients for any inquiries regarding Health and Dependent care accounts, retirement accounts, reimbursement accounts and commuter accounts. Created and monitored cases for any ongoing issues or discrepancies in a clients submitted claim or pending reimbursement, spending account debit card usage or issues, assisted in proper documentation submitted for claims, any adjustments that may have been necessary, advised of plan provisions and how the clients’ specific account works, any deadlines to utilize funds, submit claims, what their eligible expenses are and of the Health Care Reform and how it affects their accounts. Worked closely with several clients on multiple occasions, forming a trust between myself with the company and the customer.

 Became CISP compliant upon hiring, have attended two Customer Service Training classes, and took payment for parking citations, decals and immobilizations. Inventoried parking permits upon arrival from shipment, kept office clean and organized, filed paid citations and voided citations, and processed paperwork for stolen permits and permits deducted via payroll, answered incoming calls regarding locations on campus, discrepancies on accounts, or citations, etc. Maintained daily usage of a till, payments taken via cash, check and credit card and balanced at the end of each shift, Microsoft and accounting programs on computers used daily.

 Customer Service Training upon hiring. Worked the front end of the store, greeted customers, assisted customers with their parcel out to their cars, collected carts from the lots, cleaned the store, stocked the front end when necessary, directed customers to any given item, assisted cashiers with bagging groceries, maintained a positive attitude.

 Training in proper phone etiquette, Windows, Call center programs, navigating through a clients’ account, PESOC training and Client Specific training in Medical Insurance, Life Insurance, Medicare, Retiree Medical, COBRA, etc. for 4-5 different client companies during the annual enrollment season. Assisted participants with their annual enrollment, new hire enrollment, adding or removing dependents, and any inquiries about their coverage or the cost.