Mandie Simpson

• Performed detailed analysis of Medicare Part D Prescription Drug Plans (PDPs) to ensure benefit accuracy and CMS compliance.

• Conducted formulary and benefit configuration reviews to identify discrepancies and support operational improvements.

• Utilized PBM platforms and data reporting tools to evaluate claims activity and plan performance trends.

• Partnered with cross-functional operational teams to resolve plan configuration and compliance issues.

• Developed reports supporting PBM program operations and strategic plan management decisions.

Jan 2021 – Aug 2025

• Conducted pharmacy claims audits and benefit validation reviews across Medicare and commercial PBM plans.

• Evaluated operational workflows and customer service interactions to maintain regulatory and quality standards.

• Monitored performance metrics and developed reports supporting PBM compliance and operational improvements.

• Provided training and mentoring to staff on PBM procedures, Medicare requirements, and claims handling protocols.

Dec 2017 – Jan 2021

• Provided member and provider support for pharmacy benefits, prescription claims, prior authorizations, and formulary questions.

• Assisted members in navigating Medicare Part D coverage, pharmacy networks, and cost-sharing structures.

• Documented interactions and benefit determinations in PBM systems while maintaining HIPAA compliance.

• Identified recurring issues and escalated operational concerns to improve PBM service delivery and member satisfaction.