Melissa Coulter
Berea,Kentucky
Summary
Subject Matter Expert and trusted advocate skilled in research, analysis and examination of company technology and standard operating procedures. Interface and collaborate with members and internal team members, providing consultative enhancement recommendations. Implement existing procedures while staying goal oriented and optimizing outcomes in tandem with examination of company functions with an eye to improvement.
Overview
16
16
years of professional experience
Work History
Medicare Pharmacy Benefits Subject Matter Expert
Conduent - Humana Pharmacy
Lexington, KY
08.2018 - Current
- Assist Humana Pharmacy Prescription Drug Plan members: refill prescriptions, request new prescriptions.
- Assist members understand stages of drug plans.
- Documented client progress through case notes and documentation.
- Explain Annual Notice of Changes documentation
- Sent attestations for Other Insurance Investigations (OI)
- Submit exceptions to Work Force Management for team meetings, advocate trainings, advocate coachings
- Provide Subject Matter Expert (SME) services for team as needed.
- Designed and prepared technical reports, and related documentation.
- Provided customer and account services such as passwords, electronic mail accounts and troubleshooting to regain access to accounts.
Pharmacy Customer Service Representative
Conduent - Humana Pharmacy
Lexington, KY
03.2018 - Current
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Investigated and resolved customer inquiries and complaints quickly.
- Recommended available refills to customers, thoroughly explaining details.
- Met customer call guidelines for service levels, handle time and productivity.
- Responded proactively and positively to rapid change.
Agent Services Representative
Conduent - Florida BlueCross BlueShield
Lexington, KY
07.2017 - Current
- Delivered world-class customer service to Florida BlueCross BlueShield Agents.
- Assisted Florida BCBS agents via inbound phone calls, email and chat.
- Recommended products to customers, thoroughly explaining details.
- Maintained up-to-date knowledge of Medicare products and service changes.
- Completed annual Medicare certifications.
- Assisted with access to care issues.
Quality Control Technician
Hitachi Automotive Systems Americas
Berea, KY
09.2013 - 09.2015
- Evaluated samples against standards by completing measurements, visual inspections and other established tests.
- Performed thorough inspections of incoming materials and outgoing products.
- Inspected raw materials and finished products to verify quality and disposed items that did not meet safety requirements.
- Adhered to safety and clean area procedures to comply with agency and regulatory mandates.
- OSHA certification.
- Blueprint reading.
- Determined root cause of deviations and non-conforming results and implemented appropriate corrective and preventive actions throughout processes.
- Helped uncover and fix production problems in order to reduce overall defect rates.
- Inspected manufactured parts by reviewing visually and assessing dimensions.
- Reported problems and concerns to management.
- Completed supporting documentation for testing procedures, data capture forms, equipment logbooks and inventory forms.
Education
Certification - Paralegal Studies
Bellarmine University
Louisville, KY08.2023
Associate of Arts - General Education
Lexington Community College
Lexington, KY05.2007
Associate of Applied Science - General Education
Lexington Community College
Lexington, KY05.2007
High School Diploma -
Harrison County High School
Cynthiana, KY05.1998
Skills
- Microsoft Office Suite
- Presenting Cases
- Operational Efficiency
- Clerical Support
- Team Meetings
- Case Notes
- Transfer Processes
- Scheduling Appointments
- Maintaining Clean Work Areas
- HIPAA
- DOS
- Record Maintenance
Timeline
Medicare Pharmacy Benefits Subject Matter Expert
Conduent - Humana Pharmacy
08.2018 - Current
Pharmacy Customer Service Representative
Conduent - Humana Pharmacy
03.2018 - Current
Agent Services Representative
Conduent - Florida BlueCross BlueShield
07.2017 - Current
Quality Control Technician
Hitachi Automotive Systems Americas
09.2013 - 09.2015
Certification - Paralegal Studies
Bellarmine University
Associate of Arts - General Education
Lexington Community College
Associate of Applied Science - General Education
Lexington Community College
High School Diploma -
Harrison County High School