Misty Pelayo
Summary
Highly motivated and detail-oriented professional with over a decade of experience in the insurance industry. Possesses a deep understanding of the field and extensive knowledge and expertise gained from working for a well-known insurance company. Versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions.
Overview
13
13
years of professional experience
Work History
Team Lead
PharmaCord
08.2024 - Current
- Influenced positive change within the organization through strategic thinking, innovation, problem-solving abilities, and consistent leadership style.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Proven ability to learn quickly and adapt to new situations.
- Helped lead the new program launch for the Patient Assistance Program for our client
- Collaborated with others within leadership to produce new team training materials.
- Completed a prescreen for each case recommended for the PAP program, to ensure all previous procedures were complete and executed accurately.
- Actively communicated within our team chat to provide help and guidance to ensure all questions or issues were resolved in a timely manner.
- Earned trust and acceptance as a leader from case managers as we navigated the newly established program.
- Reviewed calls and helped provide feedback for call calibrations with the client.
- Communicated important program changes and reminders to case managers using multiple sources to ensure all communication style preferences were met.
- Participated and lead weekly meetings with the team.
- Volunteered to take on special projects anytime an opportunity arose.
Real Estate Broker
Angel Perry & Associates LLC
04.2018 - Current
- Communicate directly with clients
- Conduct open houses to help market for-sale properties
- Stay up to date on market trends and property values to best assist clients
- Develop positive and trusting relationships with customers by addressing individual needs
- Negotiate final price and draft sales contracts
Case Manager
Pharmacord
02.2023 - 08.2024
- Communicate directly with Patients and Health Care Providers to assist in obtaining patient's plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions
- Document all activities within the PharmaCord CORscend system in accordance with business requirements
- Report adverse events, Product complaints, special situation reports and/or medical inquiries received in accordance with Business Rules
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
Product Manager II
Humana, Inc.
10.2016 - 11.2021
- Managed all product materials for the Northeastern region
- Developed new documents and materials compliant with the Department of Insurance regulations
- Peer reviewed yearly rate renewals using excel formatting and formulas
- Revised excel documents to correspond with updated rates
- Emailed correspondence to all market managers for all changes to marketing materials and/or rates
Enrollment Specialist
Humana, Inc.
09.2011 - 11.2016
- SME (subject matter expert) for enrollment application approvals
- Researched databases for any missing information on a member's application
- Emailed correspondence to insurance agents to obtain any additional information needed to process an enrollment
- Developed a work-around in our CI system when issues would arise
Education
Certificate - Radiology
Spencerian College
Louisville, KY05-2011
Skills
- Marketing
- Project Management
- Communication
- Teamwork and Collaboration
- Daily workflow improvement
- Complex Problem-Solving
- SOP Adherence
- Leadership
- Process Improvement
- Idea Development and Brainstorming
References
Available upon request.
Timeline
Team Lead
PharmaCord
08.2024 - Current
Case Manager
Pharmacord
02.2023 - 08.2024
Real Estate Broker
Angel Perry & Associates LLC
04.2018 - Current
Product Manager II
Humana, Inc.
10.2016 - 11.2021
Enrollment Specialist
Humana, Inc.
09.2011 - 11.2016
Certificate - Radiology
Spencerian College
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