Ashley Freeman
Grovetown,GA
Summary
Dedicated medical professional with a results-oriented approach to customer service. Successfully resolves conflicts and addresses concerns, driving high levels of customer satisfaction. Experienced in utilizing Salesforce and Jiva systems to support members and providers efficiently.
Overview
8
8
years of professional experience
Work History
Prior Authorization Representative
Brighton Health Plan Solutions
New York, NY
06.2025 - Current
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Verified eligibility and compliance with authorization requirements for service providers.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Processed new medication and refill requests for authorization.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
- Streamlined operations by managing a high volume of incoming calls for medical providers seeking information or assistance.
- Coordinated with internal departments on behalf of providers to ensure timely payment resolution for claims disputes or other financial matters.
Member Support Specialist
Blue Cross and Blue Shield of Massachusetts Inc.
Remote
01.2024 - Current
- Enhanced member satisfaction by promptly addressing and resolving inquiries and concerns.
- Implemented feedback from quality assurance reviews, leading to improved performance metrics within the team.
- Developed strong relationships with members through empathetic communication and effective problem-solving skills.
- Responded to customer calls and emails to answer questions about products and services.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Upheld strict confidentiality standards while managing sensitive patient information according to HIPAA regulations.
- Interacted with insurance companies and doctor’s offices to verify patient eligibility and benefits.
- Used medical terminology knowledge to explain procedures, policies and services to patients.
- Obtained patient information to properly record and document demographics and medical histories.
- Increased access to healthcare services by assisting with insurance verification and preauthorization processes.
- Promoted patient advocacy by actively listening to their needs and working closely with the care team for resolution.
- Assisted patients in understanding how insurance coverage works and calculated copays.
- Managed incoming phone calls to resolve patient inquiries and refer calls to appropriate departments.
Pharmacy Benefits Manager
Express Employment
Remote
01.2022 - 01.2024
- Educated members about their prescription drug coverage options, empowering them to make informed decisions about their healthcare needs.
- Collaborated with healthcare providers to optimize patient care and promote appropriate medication use.
- Maintained appropriate drug records and completed reports as necessary.
- Remained knowledgeable about health insurance and other third-party payment programs to facilitate purchases.
- Reviewed prescription to confirm appropriate selection of drug, dose and check for interactions with other medications.
- Educated patients on proper medication use.
Payroll Manager
ADP
Remote
07.2020 - 11.2021
- Calculated deductions and processed payroll for employees.
- Processed retroactive pay adjustments and other special payments to make up for compensation shortfall in previous pay period.
- Offered payroll-related subject matter expertise to management and employees to resolve payroll discrepancies.
- Processed payroll garnishments such as tax liens and child support.
- Generated paper checks for employees and printed stubs for associates who received direct deposits to complete payroll distribution.
- Addressed employee inquiries regarding pay issues promptly, fostering positive relationships between management and staff members.
- Improved payroll accuracy by conducting regular audits and addressing discrepancies proactively.
- Responded to employee inquiries to provide assistance with payroll-related questions.
Customer Service Expert
T-Mobile
Hybrid
05.2017 - 07.2020
- Resolved customer complaints professionally, maintaining a positive reputation for the store as well as the brand being represented.
- Provided exceptional after-sales support, fostering long-term relationships with clients while addressing any concerns they may have had.
- Utilized CRM software to track leads, monitor progress, and maintain organized records of interactions with potential clients.
- Stayed up-to-date on the latest mobile devices and plans, ensuring accurate information was provided to customers.
- Delivered informative product presentations during staff meetings, ensuring all team members were well-versed in the current offerings.
- Assisted customers in troubleshooting issues, enhancing their user experience and satisfaction.
Education
Bachelor Of Health Science - Health Administration
Southern New Hampshire University
Hooksett, NH08.2026
High School Diploma - General Studies
Thomas Walters Josey High School
Augusta, GA05.2008
Skills
- Patience and composure
- Sales support
- Effective communication
- Customer service excellence
- Complaint resolution
- Salesforce proficiency
- Jiva expertise
- Call center operations
- Client education strategies
- Pharmacy knowledge
- Account management skills
- Team collaboration
- Multitasking abilities
- Computer proficiency
- Time management skills
- Attention to detail
- Organizational skills
- Customer needs assessment
- Positive demeanor
- Teamwork and collaboration
- Customer service
Timeline
Prior Authorization Representative
Brighton Health Plan Solutions
06.2025 - Current
Member Support Specialist
Blue Cross and Blue Shield of Massachusetts Inc.
01.2024 - Current
Pharmacy Benefits Manager
Express Employment
01.2022 - 01.2024
Payroll Manager
ADP
07.2020 - 11.2021
Customer Service Expert
T-Mobile
05.2017 - 07.2020
High School Diploma - General Studies
Thomas Walters Josey High School
Bachelor Of Health Science - Health Administration
Southern New Hampshire University