JESSICA EBLING
Las Vegas,NV
Summary
- I am always looking forward to moving on to an exciting and rewarding career, and I am always ready for new opportunities, and to learn more and more each day.
- I am very responsible, highly motivated, and punctual, and I come to work prepared every day.
- I am great at multitasking, and a great team player. I make sure to put everything I've learned and know into any position I am given, as well as to learn new material the company provides.
- I have excellent skills when it comes to adapting to new programs in the company, and I have a great knowledge of medical and pharmaceutical practices, and I am very confident with the jargon and processes.
- I have a great understanding of processing claims, and experience working in a busy call center environment.
Overview
24
24
years of professional experience
Work History
Prior Authorization Representative/Medicare Customer Service Representative
Anthem, Inc. / IngenioRx/ Elevance Health
Las Vegas, US
03.2020 - Current
- Took high-volume inbound calls from physicians, pharmacies, and members regarding the status of their prescription prior authorizations.
- I collected the exact information the doctor provided and put that information into the PA questionnaire program, which would determine if the member either gets an automatic approval authorization or is sent out for further review.
- I would speak with Medicare Part D, Medicare Supplement, and Medicare Advantage members daily about their billing information, claims, questions regarding their plan benefits, and eligibility, while providing information and solutions to their inquiries.
- I use three monitors daily, with multiple programs, to research and analyze data, to be able to assist the caller in providing a first-call resolution.
Stay at Home Mom
N/A
Las Vegas, US
03.2018 - 01.2020
- I stayed home to take care of my daughter, and now that she is getting older I am ready to get back out into the workforce.
Member Service Representative
Alorica
Las Vegas, US
07.2017 - 02.2018
- Assisted members and providers with any eligibility or benefit questions regarding their health insurance.
- I was in charge of explaining claims and denied claims to providers.
- I would make sure that my call handle time and hold time was where it needed to be according to company standards/policy.
Member Service Representative
Catamaran LLC (Now known as United Health Group/Optum Rx)
Las Vegas, US
03.2015 - 10.2015
- Assisted in taking inbound calls from Member's, Pharmacies, and Physician's
- I would assist the caller with any overrides so the member could get their medications, and I would issue test claims to check price and availability.
- Answered any questions regarding prescription benefits, prior authorizations, and specialty medications.
Sales/Service Associate/Order Processing Associate/Quality Monitoring
Williams-Sonoma, INC
Las Vegas, US
10.2012 - 11.2014
- Assisted Customers with returns, placing orders, and handling escalations
- Checked to make sure every order that came thru wasn't fraudulent
- Was a 'PAL'/ Senior Floor Lead to new associates that needed help with day to day questions
- Would listen to employees calls to make sure they were within the guidelines of the company
Bartender/Server/Expediter/ TOGO specialist/hostess
Applebee's Grill and Bar
Las Vegas, US
12.2000 - 04.2012
- I was in charge of serving and making drinks, taking food orders, answering the telephone, and expediting food orders
- Responsible for training new employees
- I would walk the floor and help take food out of kitchen and put in orders to help other employees and production on the floor
Education
Certificate - Pharmacy Technician
MedCerts
Online Learning07-2024
High school - Theater (Musical Theater, Technical Theater)
Las Vegas Academy of International Studies, Performing and Visual Arts
Las Vegas, NV06.2000
Skills
- Excellent customer service skills (25 years)
- Call Center Experience (14 years)
- Great knowledge of medical and prescription jargon
- Background in understanding many different medical and pharmacy insurance plans, and claims (Commercial, Medicaid, Medicare)
- Proficient in Microsoft Word, Excel, Outlook, and OneNote
- Can type 40 to 50 WPM
- Excellent research skills
- I can use multiple screens on one call or research
- Prior authorization process
- Decision-making
References
References available upon request.
Timeline
Prior Authorization Representative/Medicare Customer Service Representative
Anthem, Inc. / IngenioRx/ Elevance Health
03.2020 - Current
Stay at Home Mom
N/A
03.2018 - 01.2020
Member Service Representative
Alorica
07.2017 - 02.2018
Member Service Representative
Catamaran LLC (Now known as United Health Group/Optum Rx)
03.2015 - 10.2015
Sales/Service Associate/Order Processing Associate/Quality Monitoring
Williams-Sonoma, INC
10.2012 - 11.2014
Bartender/Server/Expediter/ TOGO specialist/hostess
Applebee's Grill and Bar
12.2000 - 04.2012
Certificate - Pharmacy Technician
MedCerts
High school - Theater (Musical Theater, Technical Theater)
Las Vegas Academy of International Studies, Performing and Visual Arts
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