JAMES HARRIS
Swartz Creek,MI
Summary
Energetic Supervisor successful at motivating and building positive team dynamics to accomplish aggressive goals. Dedicated to open, communicative culture where employees feel empowered to contribute to company's success.
Accomplished Supervisor focused on meeting customer expectations and achieving company goals. Drives success by directing high-producing teams while developing lasting employee rapport. Exceptional knowledge of cost-reduction methods and streamlining production processes.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Sr. Pharmacy Adjudication Supervisor
PharMerica
07.2025 - Current
- Serves as the first point of contact for day-to-day requests from the client, triaging with the Client Services team and across the enterprise to obtain resolution.
- Manages real time insurance claims, while providing customer service to clients. Analyzes and approve live claims in a timely manner as to not slow down the filling process within the pharmacy.
- Determines coverage and applies medical necessity guidelines. Identifies and clarifies any discrepancies to completed the adjudication process.
- Participates in Client and Advisor calls as established with Sr. Client Services, Executives and managers. Supporting and coordinating resolution of any takeaway items as needed. Builds and maintains relationships with carriers, TPAS, and underwriters as in placement of sophisticated insurance programs.
- Ensures technician adherence to local, state, and federal regulations (e.g., OIG/CMS guidelines) and ensures accurate patient setups.
- Produces reports on unpaid claims, pending claims, and team performance metrics for upper management.
Sr. Pharmacy Client Services Manager
Navitus
02.2023 - 07.2025
- Maintained client files with sales contracts, records of client interactions, client notes, and other information.
- Builds and maintains relationships with carriers, TPAS, and underwriters as in placement of sophisticated insurance programs.
- Develops and negotiates contract terms, rates, plans, schedules, resources, involvement, and roles/responsibilities.
- Identifies factors which influence business performance and recommends actions to improve probability and/or enhance revenue for DSG.
- Manages large-scale CRM/3D implementations to track client injuries/ request.
Senior Customer Care Manager
IQVIA
10.2021 - 02.2023
- Supervised daily operations and sales functions to maximize revenue, customer satisfaction, and employee productivity.
- Built client relationships by responding to inquiries, identifying and assessing clients' needs, resolving problems, and following up with potential and existing clients.
- Arranged transportation and documented details of discharge transition plans.
- Developed new employees and on-going performance assessment of current employees.
- Oversaw a high-volume caseload of patients using specialty drugs and devices. Delivered comprehensive reimbursement support, coordinated prior authorizations, and worked with payers to ensure timely therapy initiation.
- Conducted detailed benefit investigations and expedited approvals for complex, high-cost therapies.
- Partnered with specialty pharmacies, payers, and providers to streamline treatment access.
- Improved patient satisfaction by reducing delays and proactively resolving coverage issues
- Created customer support strategies to increase customer retention.
- Streamlined and monitored quality programs to alleviate overdue compliance activities.
Pharmacy Operations Manager
Hometown Pharmacy
05.2018 - 11.2018
- Analyzed prescribing trends to monitor compliance and prevent excessive usage. Trained pharmacy interns and newly hired technicians. Lead Media Finance meetings to discuss client budgeting vendor actual vs. variance, filling status and overall meeting plan reconciliations.
- Collaborated with Clients on Preparations of marketing recommendations, strategies and actions for the client. Oversaw work activities, performance and service quality of pharmacy staff. Checked accuracy and productivity in performance of operational activities to maintain active pace of pharmacy. Mitigated regulatory risks by coordinating audits to comply with protocols.
- Oversees patient PACE healthcare program for multiple Hometown branches.
Certified Pharmacy Technician
RiteAid Pharmacy
10.2015 - 01.2018
- Worked with insurance companies to process claims, resolve problems and obtain payments. Consulted with customers via telephone or in-person to assist with navigating pharmacy systems and completing requests.
- Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems. Transmitted claims to insurance companies for payment and reconciled EOBs.
Education
Bachelor of Science - Business Management And Administration
University of Michigan
Flint, MISkills
- Schedule development
- Department organization
- Contract management
- Change management
- Processes and procedures
- Documentation and reporting
- Quality control
- Workflow management
- Waste reduction
- Employee development
Certification
Pharmacy Technician Certification, Pharmacy Technician License
Timeline
Sr. Pharmacy Adjudication Supervisor
PharMerica
07.2025 - Current
Sr. Pharmacy Client Services Manager
Navitus
02.2023 - 07.2025
Senior Customer Care Manager
IQVIA
10.2021 - 02.2023
Pharmacy Operations Manager
Hometown Pharmacy
05.2018 - 11.2018
Certified Pharmacy Technician
RiteAid Pharmacy
10.2015 - 01.2018
Bachelor of Science - Business Management And Administration
University of Michigan