Demetria Culver

• Troubleshoot test claims and real-time adjudication errors, identifying root causes related to plan limits, formulary restrictions, eligibility, or system configuration.
• Provided support for healthcare professionals regarding medical claims processing.
• Support SRT (Specialty Resolution Team) workflows by resolving complex, escalated pharmacy and insurance issues.
• Deliver technical and web-based support for pharmacy systems, portals, and claim-processing tools.
• Analyze claim rejections and override requirements to ensure timely and accurate resolution.
• Document all interactions, actions taken, and resolutions in ticketing and CRM systems.
• Collaborate with pharmacists, insurance providers, and internal teams to resolve high-impact issues efficiently.
• Maintain strict HIPAA compliance when handling protected health information (PHI).
• Serve as a point of escalation for unresolved or high-priority pharmacy claim issues.
• Support performance metrics by reducing repeat claim errors and improving first-call resolution.
• Confirm patient eligibility and medication coverage.
• Explain formulary rules, copays, and medication restrictions.
• Worked remotely for CVS Pharmacy Health, providing customer service and support.
• Prescription & Insurance Overrides
• Prior Authorizations
• SRT Support
• Technical & Web Support
• Root Cause Analysis
• HIPAA Compliance
• Ticketing & CRM Systems
• Escalation Management

•Process residential mortgage applications, ensuring all necessary documentation is
gathered and verified.

• Collaborate with underwriters and loan officers And Customers to resolve any issues and facilitate
smooth loan processing.

•Handled the processing of FHA and conventional loans, managing all aspects from
application to closing.

• Worked closely with clients to explain loan requirements and documentation needed.

• Coordinated with title companies and appraisers to ensure timely appraisals and
inspections.

• Maintained up-to-date knowledge of mortgage lending laws and guidelines.

• Delivered exceptional customer service, resolving client questions and concerns.

• Provide guidance to first-time homebuyers on the mortgage application process and

loan options.

• Assist clients in understanding credit reports and improving their financial literacy.

• Help organize homeownership workshops and seminars for the local community.

• Analyze credit reports and assess borrower financial information to determine loan
eligibility.

• Ensure compliance with federal, state, and local mortgage lending regulations.

• Prepare closing documents and ensure timely delivery to all parties involved.

• Processed deposits, withdrawals, and transfers with high accuracy daily.
• Opened new accounts and guided clients through loan application steps.
• Maintained confidentiality of all customer banking and personal data.
• Communicated with internal departments to resolve account discrepancies.
• Utilized CRM systems for customer tracking and service follow-up.
• Entered financial data and client records into digital platforms efficiently.
• Provided exceptional service to increase customer satisfaction and loyalty.
• Handled troubleshooting for online banking and technical account issues.
• Promoted banking services and recommended financial solutions remotely.
• Managed customer concerns while meeting service-level expectations.
• WFH, Remote