Sharon Eden

Provided inbound support to members regarding pharmacy benefits, prescription coverage, and claims inquiries
Assisted with eligibility verification, pharmacy issues, and prescription processing concerns
Documented all interactions in internal systems while maintaining strict HIPAA compliance
Coordinated with pharmacies and internal teams to resolve member issues
Navigated multiple systems simultaneously to verify account and benefit information

Performed outbound telephone calls and/or other means of contact with each facility to complete to retrieve medical records via fax, mail, through remote electronic medical record access or by scheduling a visit at the provider location to retrieve medical records in a remote setting.

• Reviewed renewal enrollment forms to assess PAP Medicare
• Part D renewal eligibility for AR 2022-2023 season.
• Attention to details Identified missing information and appropriately updated the record status of information needed.
• Determined eligibility based on Medicare Part D PAP criteria and reviewed enrollments forms and records to ensure data integrity.

• Responded to inbound calls from member/provider/agent/broker inquiries regarding health insurance benefits, eligibility and claims, authorization status, diagnosis, and CPT code inquiries.

• Conducted complaint investigations initiated by customers and performed associated tasks to ensure complaint investigations are thorough, investigation conclusions are appropriate, and procedures are followed and, complaint investigations are conducted, and closed in a timely manner.

• Activated Safe Air Chemical Detection Badges for the military, law enforcement, emergency response and Industrial Companies.
• (Contract)

• Processed medical records documentation sent by providers and veterans validating medical appointments verifying information.
• Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.

• Researched disputed account issues.
• Recorded and processed received disputes to include determining the appropriate dispute classification, ordering new and reviewed existing documentation to investigate and resolve the disputes, preparing correspondence (letters, emails, and/or faxes), following up with investigation via telephone, email and/or fax, and electronically filing all documentation according to policy and procedures.

• Outbound dialing to customers who have placed orders with representatives outline in need of more information or additional information is needed to complete customers' order.
• Pulling account and order information and reading cc notes and noting account to warm transfer to an agent to complete customer's order.

• Responded to member and provider questions via telephone and written correspondence regarding plan benefits eligibility and claims.
• Analyzed problems and provided information/solutions.
• Inbound and outbound calls on Computer system.

• Inbound call center; accurately processed and updated customer orders using AS400 and 3090 Systems using data entry.
• Answered customer questions and resolved customer complaints.
• Upselling and cross selling to customers on customer merchandise orders for clothing, outdoor patio furniture, back to school items and engraving items.

• Inbound call center; accurately processed and updated customer orders using AS400 and 3090 Systems using data entry.
• Answered customer questions and resolved customer complaints.
• Upselling and cross selling to customers on customer merchandise orders for clothing, outdoor patio furniture, back to school items and engraving items.