Jeremiah Shafer

• Managing a variable workload of complaint cases filed by Medicare Part D, Medicare Advantage, and Medicaid clients.
• Researching plan, Pharmacy Benefit Management, and other sources to provide explanations and resolutions for any complaint filed.
• Assessing complaints that need to be addressed by both internal and external departments.
• Meeting both internal and CMS-mandated turnaround times
• Maintaining HIPAA and internal compliance requirements

• Provided support to Medicare Part D Medication Therapy Management (MTM) pharmacists.
• Maintained attention to detail and clear communication skills on varying tasks.
• Completed tasks with strict HIPAA compliance as well as internal and client standards.
• Performed Quality Assurance of clinical documentation to be delivered to healthcare provider's offices.
• Worked within the guidelines of Medicare Part D and Plan Sponsors to determine whether medications meet requirements for coverage of targeted medications.
• Contacted prescribers' offices for additional information for requests that are either incomplete or requiring additional information based on review criteria.
• Maintained a certain level of productivity per hour.

• Trained new pharmacy technicians on proper procedures and best practices, ensuring consistent quality of service.
• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Completed paperwork, entering prescription and insurance or billing information into patient profiles.
• Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.

• Completed daily delivery assignments while adhering to strict time constraints, ensuring consistent service quality.
• Enhanced customer satisfaction through timely deliveries and professional communication with clients.
• Adhered to all traffic laws while operating company vehicles for safe transportation of goods.

• Resolved customer service issues using company processes and policies and provided updates to customers.
• Enhanced customer satisfaction by resolving complex issues and providing timely solutions.
• Trained, oversaw, and mentored new team members to strengthen performance and job expertise.
• Handled escalated customer complaints professionally, ensuring prompt resolution and follow-up actions were taken as necessary.
• Improved team efficiency by implementing new training procedures and streamlining work processes.
• Developed reporting to match ongoing business needs
• Trained Blue Cross Blue Shield clients in reporting systems during new rollout

See above description of "Research Specialist Lead'

• Maintained detailed records of all interactions and resolutions for future reference and analysis purposes, improving overall efficiency in handling similar cases down the road.
• Assisted colleagues in navigating challenging situations by sharing expertise and offering guidance when requested or needed.
• Managed high volumes of customer inquiries for efficient resolution, enhancing overall client experience.
• Coordinated with internal departments as needed to gather information on each individual case, facilitating a more accurate and timely response.
• Handled escalated calls calmly and professionally, ensuring that even highly dissatisfied customers felt heard and supported throughout the process.
• Implemented effective communication skills to deescalate high-tension situations, fostering positive relationships between customers and the company.
• Utilized advanced problem-solving abilities to identify creative solutions for atypical client concerns.

• Managed high call volumes while maintaining exceptional levels of professionalism and accuracy throughout each interaction.
• Supported members with account management tasks, including updating personal information and troubleshooting login issues.
• Contributed to team success by consistently meeting or exceeding performance metrics in areas such as call quality and resolution time.
• Maintained detailed records of member interactions, ensuring all pertinent information was accurately documented for reference in future communications.
• Collaborated with other departments to resolve complex member situations, ensuring a seamless experience for the customer.
• Maintained up-to-date knowledge of company products and services to provide accurate information to members at all times.

• Collaborated with cross-functional teams to optimize workflows, resulting in increased productivity levels.
• Tracked daily production, and notable incidents to support operational planning and strategic decision making.
• Boosted morale, fostering a positive work environment through open communication and supportive leadership practices.
• Planned, scheduled, and delegated daily work to team of employees.
• Improved team performance by providing regular training and mentoring to staff members.
• Implemented quality control measures, significantly reducing the number of defective products produced.