Pharmacy Claims Sr Representative
Brittany Jackson
CVS Caremark
Houston
16
years of professional experience
An experienced health insurance professional proficient in pharmacy and medical benefits. Proven track record of resolving escalated matters with soft skills and long term solutions. Professional with exemplary skills and over twenty years of service related experience.
Work History
Pharmacy Claims Sr Representative
6 Years- Interpreted benefit plans and policy guidelines to provide accurate coverage determinations.
- Investigated escalated cases, coordinating follow-up with claims, eligibility, and pharmacy operations teams.
- Communicated prior authorization status, benefit exceptions, and pharmacy claim updates to members and providers.
- Ensured HIPAA-compliant handling of protected health information across all member interactions.
Customer Care Specialist
1 Year- Resolved customer inquiries across phone, chat, and email with accurate, brand-aligned service.
- Guided customers through product availability, sizing, and styling support using strong merchandise knowledge.
- Navigated order management systems to research shipment status, returns, exchanges, and billing concerns.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
Customer Care Specialist
1 Year 3 Months- Responded to customer inquiries via phone, email and web-based platforms.
- Retained at-risk customers by identifying their needs and offering tailored solutions, resulting in reduced churn rates.
- Escalated complex issues to partner teams while maintaining clear ownership and follow-through.
- Managed difficult customer situations with empathy and understanding, ultimately defusing tensions and finding mutually agreeable resolutions.
Customer Service Representative
1 Year 2 Months- Updated account records, payment statuses, and correspondence notes in collections systems with accuracy.
- Built rapport with customers by demonstrating understanding of their situation while seeking fair resolutions.
- Processed payments and applied to customer balances.
- Recognized as a top performer within the team for consistently surpassing goals and maintaining high levels of client satisfaction.
Auditor
2 Years- Prepared nightly audit reports supporting accounting review, compliance, and management decision-making.
- Enhanced financial accuracy by conducting thorough audits and identifying discrepancies in financial statements.
- Collected and reported monthly expense variances and explanations.
- Managed guest check-ins, check-outs, and room assignments using property management system.
- Resolved reservations, billing discrepancies, and service requests.
Education
112 Credit Hours Completed - Criminal Justice
60 Credit Hours Completed - General Education
12 Credit Hours Completed - General Education
High School Diploma
Skills
Health Insurance Specialist
Claims Analysis
Data Entry
Analytical and logical reasoning
Financial Auditing
Legal Research
Timeline
Pharmacy Claims Sr Representative
CVS Caremark
11.2020 - 11.2026Read More
Customer Care Specialist
Nordstrom
10.2016 - 10.2017Read More
Customer Care Specialist
Williams Sonoma Inc
06.2015 - 09.2016Read More
Customer Service Representative
ABC Financial Services
02.2013 - 04.2014Read More
Auditor
Marriott
02.2011 - 02.2013Read More
Columbia College
112 Credit Hours Completed from Criminal Justice
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Saint Louis Community College
60 Credit Hours Completed from General Education
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Missouri Western State University
12 Credit Hours Completed from General Education
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Paseo
High School Diploma
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