JAMES O. THOMAS IV

• Back-end configuration of benefit administrator platform for large companies and corporations, including the following tasks:
  •Gathering and analyzing business requirements
  •Designing and implementing configuration solutions
  •Testing and deploying configuration changes
  •Maintaining and supporting the configuration platform
• Use Gantt charts through Salesforce to schedule and track configuration projects, ensuring that projects were completed on time and within budget.
• Developed and maintained configuration documentation, including user guides, training materials, and reference documentation.
• Worked with stakeholders to resolve configuration issues and ensure that the platform met their needs.
• Implemented security and compliance controls to protect the configuration platform.
• Contributed to the development and improvement of the configuration team's processes and procedures.
• Delivered presentations and training sessions on configuration management to business stakeholders.
• Kept CM work aligned with project's configuration management plan.
• Prepared CM-related documentation for on-time delivery.
• Enhanced project management skills by defining and presenting system solutions and timelines for business needs or technical problems.

• Assigned to project to facilitate business needs
• Created and updated records and files to maintain document compliance
• Completed multiple tasks simultaneously to optimize project completion
• Sorted, opened, and routed mail and deliveries to meet business requirements
• Plan and performed work according to project schedules and established quality standards., Customer, Advocacy Group
• Responsible for managing escalated customer complaints companywide, which in some cases may require special handling
• Seek ways to determine appropriate course of action, conduct investigative steps to identify issues and draft system specifications and business requirements documents
• Perform moderately complex research to resolve customer issues and review complaints for regulatory and non-regulatory flags, and classify risks appropriately in case management system to ensure customer issues are addressed while maintaining compliance with internal company requirements and standards
• Review research evidence and documents to analyze overall claim pattern, synthesizing data into professional report that includes recommendations based on findings

• Support and assist less experienced representatives either on the spot, via telephone or chat
• Provide training on policies and procedures, new or enhanced services or procedural changes
• Provide feedback and present ideas for improving or implementing processes and tools within customer success groups
• Provide subject matter expertise and provide training on policies and procedures, new or enhanced services and procedural changes
• Executive office Intake, Specialist I
• WellsFargo Banking
• Utilized CRM system: MSP, for case management tasks and notations
• Setting clear expectations of next steps of complaint process after recapping customer issues/complaint
• Conducts Pre-Risk Assessment (PRA) by reviewing complaint for regulatory and non-regulatory flags and classifying risks appropriately in case management system to ensure customer issues are addressed

• Leveraged CRM system, Salesforce, for efficient case management, assignments, and task tracking.

• Conducted preliminary analysis using referral forms to assess the need for additional information in completing benefit verification.

• Investigated medication coverage by engaging with patient pharmacy benefit managers and meticulously documenting findings.

• Researched pharmacy services, conducting thorough examinations of Medicare, Medicaid, and Pharmacy benefits.

• Verified and documented insurance coverage for medications, administration supplies, and related pharmacy services, including prior authorization requirements and coordination of benefits.

• Ensured the coordination and provision of care aligning with safety, timeliness, effectiveness, efficiency, equity, and client-centered principles.

• Managed case assignments, regularly reviewed case progress, and made informed decisions regarding case closure.

● Managed patient profiles, assignments, and tasks efficiently using the CRM system Scriptmed.

● Communicated with referral sources, patients, and doctor's offices to gather necessary information for completing benefit verification.

● Verified and documented insurance coverage for medications, administration supplies, and related pharmacy services, including prior authorization requirements and coordination of benefits.

● Maintained pharmacy records as directed by the pharmacist, ensuring accurate and up-to-date information.

● Scheduled delivery of high-tier specialty medications only after addressing all patient needs.