Summary
Overview
Work History
Education
Skills
Timeline
Generic

Taylor Scott

Houston,Tx

Summary

Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions. Contributed to the consistent score of 98%-100% on our customer service satisfaction survey each month by ensuring customers are happy with the service provided.

Overview

7
7
years of professional experience

Work History

Specialist, Insurance II

AbbVie Endocrinology
06.2024 - Current
  • Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution. Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products. Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions. Clearly communicate and educate customers on results of the investigation.
  • Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor.
  • Quickly learn and execute business process and system changes for all drugs and channel sources as applicable. Maintain an understanding of current business procedures, deviations, and case processing for all brands and channel sources for Insurance Specialist I role to support as needed.
  • Documents information in the appropriate system of recorded formats. Accurately communicate insurance details to HCP and patients via phone, other electronic communication methods and fax, as per established policies and procedures.
  • Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations.
  • Support changing business priorities by being flexible in executing or overseeing completion of specific tasks to support the patients, products, or services we provide for all current and new products.
  • Work cross-functionally to identify and share opportunities for process and productivity improvements. Liaise between healthcare providers, insurance companies, AbbVie Patient Access Support field rep.s, Ambassadors, filling pharmacies and patients to administer the Patient Support Service programs. Educate healthcare providers, AbbVie Patient Access Support field representatives, filling pharmacies, and patients on access processes specific to their patient's insurance plan.
  • Meet or exceed department standards relative to performance metrics. Maintain a work environment that upholds privacy standards required by law and AbbVie policy.
  • Act as a resource for the Training department including providing support for training curriculum and new hires. Provide side by side coaching and assistance for Insurance Specialist Level 1s. Successfully complete role based training requirements, including passing certifications and competency assessments prior to conclusion of training period.
  • Understand and comply with all required training, including adherence to federal, state, and local laws, SPII policies and guidelines, and the policies and procedures of AbbVie Access Support and AbbVie. Perform additional tasks, activities, and projects as deemed necessary by management.

CUSTOMER SERVICE SPECIALIST

CVS HEALTH CORPORATION
10.2020 - 05.2024
  • Used consultative techniques to understand customer needs and make strategic referrals to business partners
  • Achieved high satisfaction rating through proactive one-call resolutions of customer issues
  • Ensure that proper benefits are applied to each claim by using appropriate processes and procedures
  • (e.g., claims processing policies and procedures, state mandates, CMS/Medicare guidelines, and benefit plans)
  • Took payment information and other pertinent information such as addresses and phone numbers to place orders
  • Answer incoming calls from customer and providers regarding benefits, eligibility, EOB's, authorizations, and billing/payment.

INSURANCE VERIFICATION SPECIALIST

New Era Life Insurance
01.2019 - 09.2020
  • Determined appropriateness of payers to protect organization and minimize risk
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures
  • Verified client information by analyzing existing evidence on file
  • Reviewed 200+ patient cases per week and verified insurance coverage information.

CLAIMS CUSTOMER SERVICE REPRESENTATIVE

Healthcare Perfection, BCC
05.2017 - 01.2019
  • Provided primary customer support to internal and external customers
  • Initiated outbound customer calls to review policy reviews and late payments to avoid lapse in coverage
  • Directed incoming calls to internal personnel and departments, routing to best-qualified department
  • Documented customer contact in Policy to maintain record of customer interactions and elevate quality of service
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

Education

High School Diploma -

Westfield High School
Houston, TX
05.2016

Prairie View A & M University
Prairie View, TX

Skills

  • Verbal/Written Communication
  • EOB's / Claims / Appeals
  • Medical Terminology
  • Telephone etiquette
  • Recordkeeping strengths
  • Working independently/ as well as with a team
  • Process Improvement
  • Active listening
  • Customer Support
  • Digital literacy
  • Proficient problem solving
  • HIPAA
  • Multi-tasking with attention to detail
  • Strong technical skills
  • Maintain positive service image at all times

Timeline

Specialist, Insurance II

AbbVie Endocrinology
06.2024 - Current

CUSTOMER SERVICE SPECIALIST

CVS HEALTH CORPORATION
10.2020 - 05.2024

INSURANCE VERIFICATION SPECIALIST

New Era Life Insurance
01.2019 - 09.2020

CLAIMS CUSTOMER SERVICE REPRESENTATIVE

Healthcare Perfection, BCC
05.2017 - 01.2019

High School Diploma -

Westfield High School

Prairie View A & M University

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