Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Lori Shanesy

Troy,OH

Summary

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

12
12
years of professional experience

Work History

Consumer Experience Professional II - Pharmacy Service Experience and Operations

CenterWell Pharmacy
03.2022 - Current
  • Ensure optimized interactions between business and members
  • Responsible for call transfers, first call resolution reporting and masterlist management across all call center lines of business for pharmacy; aligning with NPSt and Voice of the Customer
  • Masterlist management includes weekly collaborations with Conduent, BroadPath, Concentrix, Mattersight, and Everise external business partners
  • Daily responsibilities include managing data, building reports, making data driven recommendations for process improvements
  • Meet with executives and present data monthly covering improvements, projects, and any open tickets/issues directly affecting business area
  • Review and integrate member feedback to improve upon service level, effectively locate and present problematic areas/pain points and collaborate with teams to integrate a solution
  • Manage and continue to develop relationships with points of contact and subject matter experts across all lines of business for collaboration
  • Collaborated with PAC Team and assisted with build of Power BI dashboard through transition from Tableau.

Pharmacy Technician – HP Resolution Team

Humana Pharmacy
09.2017 - 03.2022
  • Provide support to all departments within pharmacy for aging/escalated orders, trained across multiple departments/platforms
  • Work under limited guidance while exercising discretion and judgement in prioritizing requests, while adapting to new procedures/processes and techniques
  • Work special projects as assigned by leadership
  • Assist with and submit process changes/improvements within all pharmacy departments
  • Identify gaps and proactively pursue a solution
  • Provide coaching’s to departmental leadership to improve quality and process improvement
  • Maintain and continue to build relationships within all areas across pharmacy
  • Apply professional judgment in escalated situations, while providing resolution to complex problems, execute effectively and with quality even as workload increases, and challenges arise
  • Run and work daily reports
  • Use data to capitalize on continuous innovation
  • Communicate with IT regarding system issues that arise, testing and researching to ensure operating system is working as designed
  • Collaborate with call center leadership and their new hires to provide presentations and coaching’s for areas of opportunity
  • Daily interaction with existing 3rd party clients including FliptRx and MedImpact, serving as point of contact and subject matter expert to support all departments within traditional pharmacy
  • Research, resolve and provide necessary feedback/coaching’s involving all 3rd party escalations to internal and external clients
  • Monitor and report data for 3rd parties and provide feedback both internally and externally where improvements can be made to provide a seamless customer experience.

Pharmacy Technician – Exceptions Team (Failed Claims)

Humana Pharmacy
10.2014 - 04.2015
  • Effectively resolve all insurance rejections and other billing issues
  • Verify all current and prior medical coverage for members
  • Manually bill and reprocess claims as required, send for price quotes
  • Manage and work over-the-counter orders for members
  • Process prior authorizations, including follow up after submission
  • Process all refill too soon, therapeutic duplication, maximum daily dosage, and non-formulary drug exceptions
  • Maintain set production and quality standards on monthly and quarterly basis.

Pharmacy Technician - Item Entry

Humana Pharmacy
05.2012 - 10.2014
  • Enter all prescriptions in incoming orders
  • Cross trained in all item entry queues
  • Perform side by side support with new hires and fellow technicians to improve speed, accuracy, and ensure processing guidelines are being followed
  • Created PowerPoint presentation on quality with peers to focus on quality tips and tricks, targeting specific problem areas
  • Communicate daily with leaders as well as other departments on system defects
  • Assist other departments based on business needs
  • Work various special projects including IEMDU, maintaining all doctor profiles contain accurate and up to date information
  • Maintain accountability, build trust and collaborate with leaders and fellow associates on daily operations. Attend triage meetings for operational prod turns within ePost system to collaborate with program managers and test all system updates for defects
  • Train new hire associates on working Item Entry’s queues, navigating through ePost, Dispensing Guidelines, QuaRx Errors during nesting period.

Education

No Degree -

Certified Pharmacy Technician

High School Diploma -

Melbourne High School
Melbourne
05.2000

Skills

  • Motivated Self-Starter
  • Attention to Detail
  • Passion for Learning
  • Problem Resolution
  • Committed to Quality
  • Skilled in ePost, Excel, Argus, CRM, Word, PowerPoint, Outlook, Power BI, Tableau, InMoment, IDEA Tool, Teams
  • Excellent Communication

Accomplishments

  • Awarded REACH Incentive
  • Member of IEMDU team project saving Humana Pharmacy over $900,000
  • Awarded 6 Shining Star Awards
  • Quality Peak Program Champion
  • Serve as POC for First Call Resolution and Transfers for all LOB’s within pharmacy call center
  • Member of WNRG, working vendor booths for Inclusion and Diversity Day
  • Served as POC/SME for Third Party Clients, FliptRx and MedImpact

Timeline

Consumer Experience Professional II - Pharmacy Service Experience and Operations

CenterWell Pharmacy
03.2022 - Current

Pharmacy Technician – HP Resolution Team

Humana Pharmacy
09.2017 - 03.2022

Pharmacy Technician – Exceptions Team (Failed Claims)

Humana Pharmacy
10.2014 - 04.2015

Pharmacy Technician - Item Entry

Humana Pharmacy
05.2012 - 10.2014

No Degree -

Certified Pharmacy Technician

High School Diploma -

Melbourne High School

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