LTanya Singleton

Resolved customer issues following medical guidelines to recommend appropriate solutions or alternatives for first call resolution satisfaction regarding their medication concerns. Assisted with price checks, new orders, refills, transfers, mail order requests, prescription overrides when appropriate and benefit updates.

Provided customer with short term disability claims status updates, explained claim processes and insurance procedures for routine and complex questions. Handled complaint research and resolution. Documented service requests and tracked follow-up results.

Provided customer with short term disability claims status updates, explained claim processes and insurance procedures for routine and complex questions. Handled complaint research and resolution. Documented service requests and tracked follow-up results.

• Interpreted member plan policies, benefit coverage and referral guidelines. Adjudicated prior authorization requests for approval to obtain surgical, specialty, alternative medicine, skilled nursing, LTAC, Behavioral Health and Durable Medical medical referrals. Managed a high volume of referrals daily while consistently meeting and exceeding daily metrics and requirements.