Erin Murphy Carrillo
Lagrange,KY
Summary
Knowledgeable healthcare claims and pharmacy specialist with extensive experience in claims auditing, member reimbursement, prior authorizations, and process improvement. Recognized for consistently exceeding production and quality metrics while contributing to various projects, training initiatives, and system enhancements across Medicare and commercial lines. Acknowledged for outstanding service, accuracy, and peer support, with a proven track record as a qualified Processing Representative skilled in efficient data entry and processing tasks. Strong analytical and problem-solving skills complement a commitment to exceptional customer service and driving continuous workflow improvements.
Overview
19
19
years of professional experience
Work History
Claims Processing Representative 3 / Specialist
Humana Inc.
La Grange, KY
04.2017 - 11.2025
- Medicare, Medicaid and commercial lines
- Document/process creation, updates, FAQ's, System testing; SME and trainer for new/existing processes
- Leverage experience in HCPR and MIT systems to improve service quality and case resolution. Process member reimbursement requests for pharmacy/outpatient medications
- Process requests for reimbursement for Pharmacy claims servicing Medicare, Medicaid, Commercial, Home Office (Employee) and Li-Net lines of business. SME in all areas of reimbursement. Training and Nesting SME.
- Train new associates
- Exceed metrics using Humana, Argus, and Lotus Notes; trained in multiple operational queues.
- Error review and coaching fellow associates on utilization of process documents and process.
UM Coordinator 2 (Direct Member Reimbursement, HCPR)
Humana Inc.
La Grange, KY
11.2015 - 04.2017
- Process requests for complex authorizations (injections, chemotherapy, allergy, orthopedic, ocular)
- Correspond with members/providers, enter authorizations, process pharmacy claims.
- Exceed metrics requirements of 95% using Humana, Argus, and Lotus Notes; trained in multiple operational queues.
- Mentored junior staff, providing guidance on best practices and encouraging professional development opportunities.
Claims Analyst
The Rawlings Group
La Grange, KY
01.2010 - 10.2015
- Coordination of Benefits-Audit files to determine primacy and errors for Medicare re-billing; conduct newborn audits per NAIC/state mandates
- Pursue overpayments and initiate provider refunds; specialize in newborn audits and commercial/Medicare claims
- Liaise with insurers for primacy, utilize multiple data systems; four-time platinum performer, maintained $2.5 million revenue
Customer Care Specialist
Humana Inc.
Louisville, KY
11.2006 - 12.2009
- Process approximately 20 phone/faxed prior authorization drug requests; provider/member correspondence; pharmacy claims entry
- Exceeded metric expectations; utilized Humana Internal systems, Argus, Lotus Notes; Cross-trained for Right Source Pharmacy operations
- Resolved customer inquiries efficiently, ensuring high satisfaction levels.
- Mentored new team members on best practices for customer engagement.
Education
Diploma - Medical Assisting
Northwest College
West Covina, CA06-1989
Skills
- Medical & Pharmacy Claims Processing
- Reporting for case management
- Prior Authorizations (Injections, Chemotherapy, Allergy, Orthopedics, Ocular Treatments) in order for our members to obtain necessary medications in an expedient time frame
- Expertise in Medicare, Medicaid, and commercial lines
- Payment Integrity
- Overpayment analysis
- Process Reviews, Document Creation & System Testing
- Analytical Thinking
- Multi-Task Organization, Virtual work, Teams and Zoom
- Subject matter expert support
- Facilitation expertise
- Communication Phone, Email, Mail, Fax2mail
- Skilled in Microsoft Office applications, Humana Internal Systems, One Note, Co-Pilot Outlook, Power Point
Accomplishments
- Achieved SME status through effectively helping with Peer to Peer training.
- Discovered and resolved discrepancies in training documents which led to the re-write and facilitation of training curriculum .
- Achieved KPI excellence by completing all tasks and projects with accuracy and efficiency.
- Collaborated with the Quality Assurance team in the development of new training and error resolution processes. .
Awards & Recognition
Human of Pharmacy (2025), STAR Award (2017) (2018) (2019) (2020) (2021) (2022) (2023) (2024) (2025), Perfect Service Award (2007, 2008, 2009), Champion Award (2007), Award of Excellence: Five months zero errors (2009), Outstanding Peer to Peer Perfect Service Award, Q12 Committee (2009), Four-time Platinum Performer (Rawlings Group)
Timeline
Claims Processing Representative 3 / Specialist
Humana Inc.
04.2017 - 11.2025
UM Coordinator 2 (Direct Member Reimbursement, HCPR)
Humana Inc.
11.2015 - 04.2017
Claims Analyst
The Rawlings Group
01.2010 - 10.2015
Customer Care Specialist
Humana Inc.
11.2006 - 12.2009
Diploma - Medical Assisting
Northwest College