ANESHIA S. DAVIS
OPTUMRX
Aurora,IL
16
years of professional experience
Senior pharmacy benefit professional with 13+ years of experience across PBM operations, pharmacy audit, client contract interpretation, compliance, and project leadership. Proven success leading complex audit engagements, partnering with Finance, Legal, Compliance, and Operations teams, and translating pharmacy benefit data into actionable business recommendations. Recognized for building strong stakeholder relationships, mentoring teams, and improving operational performance. I am seeking to leverage deep PBM expertise in a client-facing Senior Account Executive or Pharmacy Consultant role.
Work History
Internal Audit Consultant
3 Years 10 Months- Serve as the primary audit consultant supporting a portfolio of 20+ internal and external clients, providing strategic recommendations to reduce operational and financial risk.
- Directed all phases of Corrective and Preventive Action (CAPA) process, validating actions and partnering with business leaders to implement sustainable improvements.
- Analyze pharmacy claims, operational metrics, contracts, policies, and benefit plan documents to identify compliance gaps and operational opportunities.
- Analyzed pharmacy claims, operational metrics, contracts, policies, and benefit plan documents to identify compliance gaps and operational opportunities for enhanced performance.
- Present executive level audit findings and strategic recommendations to senior leadership and key stakeholders.
- Led continuous improvement initiatives to enhance audit quality, operational efficiency, and client satisfaction across engagements.
- Mentor interns and new analysts, providing technical guidance and supporting professional development.
Senior External Audit Analyst
4 Years 4 Months- Manage external PBM audits supporting commercial clients while serving as the primary liaison between consulting firms and internal leadership.
- Interpreted pharmacy benefit contracts and plan design documents to ensure contractual compliance and accurate benefit administration.
- Facilitated audit meetings with internal and external stakeholders, building strong client relationships and driving timely resolution of audit findings.
- Partnered with Finance and Legal during audit settlement negotiations that resulted in financial recoveries.
- Conducted historical pharmacy claims research using RxClaim to validate audit findings and support complex investigations.
- Supported high profile commercial client audits while mitigating operational and financial risk.
- Mentored new employees and contributed to team training initiatives.
Benefit Verification Specialist
5 Months- Verified medical and pharmacy benefit eligibility for specialty medications.
- Coordinated prior authorizations and benefit investigations while ensuring compliance with payer requirements.
- Reviewed specialty pharmacy coverage and reimbursement guidelines.
Data Entry Specialist
6 MonthsSenior Quality Audit Analyst
9 Months- Performed quality audits supporting pricing operations and pharmacy claims processing.
- Conducted data analysis and communicated findings to business analyst and leadership.
- Led quality improvement initiatives and process enhancement projects.
Team Lead/Senior Member Services Representative
3 Years 6 Months- Led teams supporting Medicare and Commercial pharmacy benefits.
- Managed escalated client issues while coaching representatives to improve quality and service performance.
- Partnered with leadership on operational improvement projects, training initiatives, and mobile application enhancements.
Accounts Activation Specialist, Resource Specialist/Trainer
2 Years 3 MonthsEducation
Pharmacy Technician Certificate
Medical Office Specialist Certificate
Skills
Pharmacy Benefit Management (PBM)
Client Relationship Management
Pharmacy Consulting
CAPA Leadership
Process Improvement
Contract Review
Pharmacy Claim Analysis
RxClaim
Strategic Planning
Audit & Compliance
Commercial & Medicare Pharmacy Benefits
Executive Presentations
Project Management
Cross-functional Leadership
Microsoft Excel
Data Analytics
Timeline
Internal Audit Consultant
OPTUMRX
10.2022 - CurrentRead More
Senior External Audit Analyst
OPTUMRX
06.2018 - 10.2022Read More
Benefit Verification Specialist
ORSINI HEALTHCARE
01.2018 - 06.2018Read More
Data Entry Specialist
JP Morgan Chase
01.2017 - 07.2017Read More
Senior Quality Audit Analyst
OPTUMRX/CATAMARAN
10.2016 - 07.2017Read More
Team Lead/Senior Member Services Representative
OPTUMRX
04.2013 - 10.2016Read More
Accounts Activation Specialist, Resource Specialist/Trainer
Archipelago Learning/Education City
11.2010 - 02.2013Read More
First Institute
Medical Office Specialist Certificate
Read More
Penn Foster College
Pharmacy Technician Certificate
Read More