Molly Caldwell
Tempe,AZ
Summary
Strong understanding of Medicare, Medicaid and Commercial Insurance
Strong writing, speaking and empathetic listening skills
Driven to excel independently and in a Team environment for the success of everyone.
Able to learn quickly and follow company protocol
Proficient in Salesforce, Microsoft Office, Excel, Outlook and Verint.
Overview
12
12
years of professional experience
Work History
CASE MANAGER
Mckesson
Scottsdale, AZ
11.2019 - Current
- I have an in-depth understanding of Medicare and Medicaid programs
- I effectively utilize internal resources to conduct external research to identify alternate funding sources as needed
- I work in a fast-paced, high-volume contact center with a variety of product support programs managing complex reimbursement issues
- I have an in-depth understanding of insurance plans and benefit structures needed to obtain detailed benefit information to maximize plan benefit's
- I work closely with healthcare providers and patients to assist with appeal management for claim denials
- Utilized company specific software along with Sales Force, Microsoft office, Outlook and Excel
- I work with physicians and payers to advocate for product-specific protocol, therefore
- I communicate product benefits and efficacy while positively influencing payer policy
- I obtains payer-specific prior authorization and documentation requirements and facilitate the prior authorization process for patients and healthcare providers
Inside Sales Representative
Dexcom
Mesa, AZ
10.2018 - 07.2019
- Conducted Insurance Benefit Investigations and conveyed coverage to the customer
- Took calls on patient inquiries, product/service concerns, and technical issues relating to Dexcom product
- Served as first point-of-contact for patients and medical professionals on all technical and service levels
- Coordinated with Quality Assurance to ensure customer satisfaction.
- Responded to patient phone calls and emails with troubleshooting tips and specific instructions
- Consistently achieved monthly sales quotas and Key Performance Metrics
- Used software and databases to document and analyze patient and product information
- Multitasked while handling a variety of sales and problem solving matters with strong customer service skills
- Strong verbal and written communication skills, including effective listening skills and ability to communicate accurately and effectively over the telephone, through email and other business correspondence
- Superior phone skills while showing empathy to customers
- Retained detailed information needed to troubleshoot and solve problems
- Worked independently and as a team player within a department as well as with other departments
Health and Life Insurance Agent
Humana
Phoenix, AZ
04.2018 - 12.2018
- Developed relationships with providers and networks to achieve favorable client coverage.
- Negotiated with insurers to secure industry-leading health insurance coverage for clients.
- Monitored changes in health insurance laws and regulations to verify continuous compliance.
- Developed and implemented marketing strategies to drive health insurance sales.
- Responded to customer inquiries regarding health insurance coverage and policies to assist with informed decision-making.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Developed and maintained client databases to track customer service interactions and evaluate service quality.
- Negotiated contracts and terms of sale with potential customers.
- Determined financial needs by assessing existing coverage and aligning new products and services with long-term goals.
Clinical Pharmacy Review
Humana
Tempe, AZ
12.2011 - 03.2018
- Used strong verbal and written communication skills, including effective listening skills and ability to communicate accurately and effectively over the telephone
- Worked at Humana Clinical Pharmacy Review assisting Patients and Health care Providers with Prior Authorizations and Appeal submissions.
- I also worked with Humana Specialty Pharmacy, Rx Education, assisting Patients and Providers with the process of ordering prescriptions
- Worked with company software along with Outlook, Microsoft Office and Excel
Education
Licensed Health And Life Insurance Agent - Health And Life Insurance
Health And Life Insurance Online Self Study
Tempe, AZ04.2018
Nationally Certified Pharmacy Technician - Pharmacology
Apollo College
11.2002
Skills
- An in-depth understanding of Medical Insurance
- Ability to communicate product benefits positively according to payer policy
- Team player
- Problem Solving skills and Conflict Resolution
Additional Information
- Apr 2018 Relevant Coursework License #14767247 - E fective 04/05/2018 - 06/30/2021
- Arizona Health & life Insurance License – License #14767247 - E fective 04/05/2018 - 06/30/2021 Pharmacy Technician Certi cation - License # VA00049723 - E fective 12/04/2002 - 06/29/2010
Timeline
CASE MANAGER
Mckesson
11.2019 - Current
Inside Sales Representative
Dexcom
10.2018 - 07.2019
Health and Life Insurance Agent
Humana
04.2018 - 12.2018
Clinical Pharmacy Review
Humana
12.2011 - 03.2018
Licensed Health And Life Insurance Agent - Health And Life Insurance
Health And Life Insurance Online Self Study
Nationally Certified Pharmacy Technician - Pharmacology
Apollo College