Results-driven customer service representative with expertise in prior authorization processing and healthcare communication. Known for maintaining professionalism while resolving complex issues, ensuring optimal patient and provider satisfaction.
Overview
11
11
years of professional experience
Work History
Customer Service Representative
Alorica
WFH
01.2020 - Current
Delivered telephone support to patients, prescribers, pharmacies, insurance companies, and healthcare professionals, ensuring clear communication and effective problem resolution.
Obtain and verify information needed to assist providers and pharmacies with triaging prior authorization requests.
Process and troubleshoot incoming prior authorization requests for various medications.
Research and analyze electronic and manual claims and troubleshoot issues in accordance with individual benefit requirements.
Communicate prior authorization criteria and requirements clearly to healthcare providers.
Serve as a provider helpdesk resource by assisting providers with submitting prior authorization requests and providing formulary product information.
Communicate prior authorization request status and related information to providers in a timely and professional manner.
Maintain accurate and thorough documentation of customer and healthcare related information.
Maintain working knowledge of Medicare D, Medicaid, and Exchange programs.
Deliver professional and courteous service while handling sensitive customer and healthcare related inquiries.
Customer Service Cashier
Walmart
Madison, AL
08.2015 - 12.2019
Processed customer transactions efficiently using point-of-sale systems.
Assisted customers with inquiries and resolved issues to enhance satisfaction.
Maintained accurate cash drawer, ensuring balance at shift end.
Trained new cashiers on operational procedures and customer service protocols.
Developed rapport with regular customers, fostering loyalty and repeat business.
Handled high-pressure situations calmly, maintaining composure during busy periods or difficult interactions.
Resolved customer complaints with professionalism and empathy, resulting in increased customer loyalty.
Resolved customer complaints and maintained clean and tidy checkout area.
Promoted a positive shopping experience by greeting customers warmly upon entry and providing assistance as needed.
Utilized POS system to handle customer cash and credit card transactions.
Provided support to fellow cashiers by stepping in during breaks or assisting with complex transactions as needed.
Processed returns and exchanges with care, adhering to store policies while prioritizing customer satisfaction.
Customer Service Representative / Prior Authorization Reviewer at TRICARE AllianceCustomer Service Representative / Prior Authorization Reviewer at TRICARE Alliance
Customer Service and Coverage Review Representative at Cigna/Express-ScriptsCustomer Service and Coverage Review Representative at Cigna/Express-Scripts