Alma Campa

Work History

Humana

06.2023 - 09.2025

Answered incoming calls from members and providers, addressing inquiries regarding medical plans and benefits. Handled questions on referral status, prescription benefits, and prior authorization processes. Provided information on available providers, claims status, and transportation assistance. Emailed members lists of local providers in network. Assisted members with long-term care plans and durable medical equipment requests. Submitted requests for changes to care managers or transferred calls to appropriate departments. Updated member demographics to ensure accurate records. Managed inquiries related to coordination of benefits and pharmacy services.

Onecall (remote)

10.2021 - 07.2022

Managed patient communications to schedule or reschedule diagnostic tests efficiently. Verified prescriptions prior to contacting providers' offices for appointment scheduling. Coordinated with referring physicians to amend prescriptions when necessary. Documented all interactions with patients, referring doctors, providers, and adjusters. Conducted comprehensive intake for new patients not yet in the system. Followed up directly with referring doctors if prescriptions remained unreceived after two days. Voided claims in cases of no response from patients regarding appointments. Facilitated transportation arrangements for patients attending appointments.

QTC Management Inc. - A Lockheed Martin Co

08.2015 - 07.2016

Answer incoming calls from patients calling to schedule appointments with Providers for assessments on their disability claims with the VA. Obtain and or verify their demographics, update new information as needed. Assist them with rescheduling appointments. Cancelling their claim if requested. Take calls from clinics adding diagnostics to office visits such as x-rays. or labs. Assist patients with their inquires on their reimbursements checks on mileage, if qualified when their appts. at clinic was past certain distance.

Aetna

05.2014 - 03.2015

Answer all incoming calls from members with questions on their benefits, such as copays for office visits, deductibles on procedures in and out of network. Assisting members with questions on their claims. Taking calls from pharmacies as needed on transactions. Answered calls from providers with their inquiries, questions on eligibility or verification of benefits, claims status, appeals status, reasons of denials.

CVS Caremark

10.2012 - 07.2013

Answer incoming calls from members requesting refills on their prescriptions, and taking their payment on their order. Answering members inquiries on their prescription benefits. Assisting them with prescription denials at retail pharmacies, for reasons such as too early to refill, not a covered or excluded medication depending on their coverage. Answer calls from pharmacies, providers on member's coverage or any inquiries on overrides per member's request. Assisting member's of prior authorizations new or renewals.

United Healthcare

03.2011 - 03.2012

Answer all incoming calls from members, providers, hospitals, Imaging centers. Answering any questions on their insurance plans, co-pays, general benefits verifying eligibility and coverage for providers. Assisting providers with any claim inquiries, denials, appeals. Explaining to members their co-insurance and out of pocket. Assisting pharmacies with any questions they might have on why a script was not covered. Assigning new pcp's to members requesting due to quality of care, service, and or access. Researching specialist in network. Assisting member's on their questions regarding their additional services such as vision plan, transportation, dental plans, and Dme benefits.