Miylisha Staton

Prime Therapeutics is a pharmacy benefit manager for some BCBS plans. As a member service specialist at Prime Therapeutics:

• I answer inbound calls from members, pharmacies, insurance brokers, and providers
• I Initiate prior authorizations, formulary exceptions, and quantity limits request over the phone
• I provide explanation of benefits
• I provide quotes for the cost of medications
• I check status of prior authorizations using cover my meds and single view
• I place outbound calls to members, pharmacies, and providers for follow ups when necessary
• I follow HIPPA guidelines to assure I am not providing third parties with members confidential information
• I notate members account to track discussion on calls
• I use right fax to send forms to providers
• I send emails to members
• I provide alternatives to members when they state that medication is not affordable
• I process overrides for members that is approved by the insurance plan as long as the member meet the requirements
• I place calls to multiple parties to resolve issues or concerns for members
• I assist pharmacies with rejections and I provide prior authorization dates and prior authorization numbers

Capgemini is a third party company that process claims for CVS.

• I processed refill too soon claims, DUR rejects, secondary rejections, ECS rejections, and more
• I processed more then 40 member claims a day
• I used availity to check members insurance coverage
• I made outbound calls to members insurance companies to get assistance with rejections
• I initiated prior authorizations for members
• I made outbound calls to members to discuss issues with their claims
• I notated members account for the next representative who would follow up with members claim
• I used outlook to send emails to different departments for assistance

Convergys was a third party company that took inbound calls for Us Cellular.

• I handled customer inquiries courteously and professionally
• I actively listened to customers, handled concerns quickly and escalated major issues to supervisor
• I processed payments for customers
• I performed upgrades
• I answered constant flow of customer calls with minimal wait times
• I assisted customers with changing their plan
• I explain members their bill and causes of increase
• I updated account information to maintain customer records

• Remained calm and poised when dealing with difficult customers or during busy shifts
• Kept server areas clean and stocked to increase efficiency while working tables
• Used cash registers and credit card machines to cash out customers
• Greeted new customers, discussed specials, and took drink orders
• Maintained customer satisfaction with timely table check-ins to inquire food and beverage needs
• Collaborated with kitchen staff to correctly update customers on unavailable dishes and wait times
• Followed health and safety regulations relevant to hospitality industry to minimize accidents, incidents and liability to restaurant