Felicia Wortham
Glenn Heights
Summary
Experienced Customer Service Professional with over 10 years in healthcare, insurance, and claims processing. Adept at handling high-volume inbound calls and resolving escalated issues while guiding members through complex healthcare processes. Proven track record in prior authorization, claims processing, and educating customers about their health benefits. Compassionate, detail-oriented, and skilled at leveraging advanced computer systems to support team members and customers alike.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Prior Authorization Technician
Lancesoft Staffing – CVS Caremark
08.2023 - 08.2024
- Processed prior authorization requests via inbound/outbound calls and fax submissions
- Assisted providers and members with medication approvals and resolving escalated issues
- Navigated multiple systems (MHK, RxClaim, CAS, Salesforce NextGen, AS400, Compass) for accurate documentation
- Contacted doctor’s offices to retrieve missing diagnosis codes, ensuring timely medication approvals
Claim Representative
Rose International – Sedgwick Government
05.2023 - 06.2023
- Answered inbound calls from providers and members regarding claim status and processing
- Verified procedure, CPT codes, and diagnoses to determine prior authorization needs
- Resolved escalated claim-related inquiries in line with company policies
Prior Authorization Technician
Apidel Technologies
10.2022 - 03.2023
- Managed processing of prior authorization faxes and coordinated with healthcare providers
- Ran test claims and verified rejection reasons to support accurate claim processing
- Documented and tracked requests using systems like MHK, RxClaim, Peoplesafe, CAS, and AS400
Customer Service Representative
BC Forward Staffing
03.2021 - 04.2022
- Handled high-volume inbound calls and addressed complex account inquiries
- Verified documentation (proof of income, wages) to resolve account issues and prevent fraud
- Delivered prompt, professional support while adhering to state protocols
Customer Service Representative / Financial Representative
New York Life Insurance Company / Axelon Staffing
11.2017 - 08.2020
- Processed complex financial transactions, including partial withdrawals and loan requests
- Assisted clients in understanding insurance policies, premium payments, and disbursements
- Maintained confidentiality and accuracy in handling sensitive financial data
Benefit Investigator
Cardinal Health
11.2015 - 07.2016
- Processed enrollments and verified insurance benefits for patient medications
- Coordinated with doctor’s offices and insurance carriers to resolve benefit discrepancies
- Managed approximately 100 calls daily in a fast-paced call center environment
Customer Service Representative
Medco Health Solution
05.2006 - 05.2013
- Provided support to Medicare Part D patients regarding prescription claims, refills, and order status
- Assisted with prior authorization processes by liaising with PA departments and pharmacists
- Demonstrated empathy and maintained professionalism in high-stress situations
Education
Diploma - Math, Science, English
David W. Carter High School
Dallas, TX05.1982
Skills
- Healthcare Customer Service & Advocacy
- Escalated Call & Conflict Resolution
- Claims Processing & Prior Authorization
- Technical Proficiency
- Communication & Empathy
- Billing/Finance & Eligibility
- MHK
- RxClaim
- Peoplesafe
- CAS
- AS400
- Compass
- Salesforce NextGen
- Microsoft Teams
- Data Entry
- Typing Speed
Certification
- Certified Notary Public, 06/30/25
- Licensed Realtor, 08/01/24 - 08/31/26
Additional Information
Authorized to work in the US for any employer., Proven ability to listen skillfully, build rapport, and respond compassionately under pressure., Strong understanding of consumer-driven healthcare, billing/finance, and eligibility processes.
Awards And Assessments
- Notary Public Award, 06/01/21
- Customer Service Assessments, 09/01/21, 08/01/20
Technical Proficiencies
MHK, RxClaim, Peoplesafe, CAS, AS400, Compass, Salesforce NextGen, Microsoft Teams, 8520, 40
Timeline
Prior Authorization Technician
Lancesoft Staffing – CVS Caremark
08.2023 - 08.2024
Claim Representative
Rose International – Sedgwick Government
05.2023 - 06.2023
Prior Authorization Technician
Apidel Technologies
10.2022 - 03.2023
Customer Service Representative
BC Forward Staffing
03.2021 - 04.2022
Customer Service Representative / Financial Representative
New York Life Insurance Company / Axelon Staffing
11.2017 - 08.2020
Benefit Investigator
Cardinal Health
11.2015 - 07.2016
Customer Service Representative
Medco Health Solution
05.2006 - 05.2013
Diploma - Math, Science, English
David W. Carter High School
Similar Profiles
Kellie L. GerowKellie L. Gerow
Data Entry Pharmacy Technician at Cvs Caremark Specialty Pharmacy through A-Line StaffingData Entry Pharmacy Technician at Cvs Caremark Specialty Pharmacy through A-Line Staffing
Diantha AshfordDiantha Ashford
Manager, Contract Negotiator at CVS / Aetna - Contracting Role Through LanceSoftManager, Contract Negotiator at CVS / Aetna - Contracting Role Through LanceSoft
LAJAÉ FULLERLAJAÉ FULLER
Customer Service Representative at CVS CaremarkCustomer Service Representative at CVS Caremark