Betsabe Lopez
Temple
Summary
Healthcare Operations Leader with 20+ years of experience in health plan administration, customer service, and pharmacy benefits. Achieved operational efficiency and enhanced team performance through effective employee development, workforce management, and compliance initiatives. Focused on building collaborative relationships and resolving complex issues while delivering value to members and stakeholders.
Overview
2
2
Languages
1
1
Certification
24
24
years of professional experience
Work History
RX OPERATIONS SUPERVISOR
Baylor Scott & White Health Plan
Temple, TX
09.2023 - Current
- Lead daily operations for the Pharmacy Customer Service and Operations team, ensuring service, quality, productivity, and compliance goals are achieved.
- Supervise, coach, and develop team members through performance evaluations and ongoing professional development.
- Review and approve employee timesheets, PTO requests, and attendance records to maintain staffing coverage and ensure operational continuity.
- Manage complex escalations and led process improvement initiatives while collaborating with internal departments and representing the organization at open enrollment events and health expos.
- Serve as a liaison between members, operational teams, and internal departments to resolve benefit, eligibility, and coverage-related concerns.
PHARMACY SERVICES SPECIALIST II
Baylor Scott & White Health Plan
Temple, TX
04.2015 - 09.2023
- Served as subject matter expert and primary resource for the Pharmacy Customer Service team, supporting members, providers, pharmacies, and employer groups.
- Resolved complex claims, eligibility, and prior authorization issues while ensuring compliance with health plan policies and procedures.
- Trained and mentored new employees, maintained departmental resources, and supported daily operational workflows.
- Collaborated with enrollment and eligibility teams to resolve coverage discrepancies and support benefit-related inquiries.
LEAD MEMBER RELATIONS REPRESENTATIVE / MEMBER RELATIONS REPRESENTATIVE
Baylor Scott & White Health Plan
Temple, TX
06.2008 - 03.2013
- Provided pharmacy benefit support to members, providers, and pharmacies, delivering exceptional customer service and issue resolution.
- Processed prior authorizations and resolved claims, eligibility, and coverage issues to ensure timely access to medications.
- Trained new employees and represented the Pharmacy Department at benefit fairs and outreach events, educating members on available benefits and services.
ACCOUNTS RECEIVABLE CLERK / COLLECTIONS & BILLING DIRECTOR SECRETARY
United Regional Health Care Systems Health Plan
Wichita Falls, TX
01.2008 - 03.2008
- Supported billing, collections, accounts receivable, and administrative operations.
- Maintained records, processed invoices, tracked payments, and managed correspondence.
- Collaborated with billing and customer service teams to resolve account concerns.
CUSTOMER SERVICE REPRESENTATIVE
Scott & White Health Plan Prescription Services
Temple, TX
05.2004 - 10.2007
- Delivered pharmacy benefit support to members, providers, and pharmacies, ensuring accurate access to necessary services.
- Processed prior authorizations while resolving claims and eligibility issues to facilitate timely member care.
- Assisted with training new staff on pharmacy processes and procedures, monthly reporting, and manual claims adjudication.
BANK TELLER
Central National Bank
Temple, TX
11.2002 - 05.2004
- Delivered exceptional customer service while processing a variety of financial transactions.
- Processed deposits, withdrawals, transfers, loan payments, and account inquiries with accuracy and attention to detail.
- Maintained confidentiality and compliance with banking regulations while supporting customer trust and satisfaction.
Education
High School Diploma -
Belton High School
Belton, Texas05-2001
Skills
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook
- HealthEdge
- HealthRules
- Optum Rx
- Judi Rx
- Amisys
- CRM Systems
- Process Improvement
Certification
- Pharmacy Technician Certification Board (PTCB) National Certified Pharmacy Technician
- Texas State Board of Pharmacy (TSBP) Registered Pharmacy Technician
CORE COMPETENCIES
- Team Leadership
- Employee Development
- Workforce Planning
- Staff Scheduling
- Performance Management
- Benefits Education
- Eligibility Verification
- Enrollment Issue Resolution
- Claims Processing
- Prior Authorization Management
- HIPAA Compliance
- Regulatory Compliance
- Process Improvement
- Customer Service Operations
- Conflict Resolution
- Bilingual (English/Spanish)
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
RX OPERATIONS SUPERVISOR
Baylor Scott & White Health Plan
09.2023 - Current
PHARMACY SERVICES SPECIALIST II
Baylor Scott & White Health Plan
04.2015 - 09.2023
LEAD MEMBER RELATIONS REPRESENTATIVE / MEMBER RELATIONS REPRESENTATIVE
Baylor Scott & White Health Plan
06.2008 - 03.2013
ACCOUNTS RECEIVABLE CLERK / COLLECTIONS & BILLING DIRECTOR SECRETARY
United Regional Health Care Systems Health Plan
01.2008 - 03.2008
CUSTOMER SERVICE REPRESENTATIVE
Scott & White Health Plan Prescription Services
05.2004 - 10.2007
BANK TELLER
Central National Bank
11.2002 - 05.2004
High School Diploma -
Belton High School