Pharmacy Technician Customer Service
Resume:
Darrel W. Davis, Jr.
Land O’ Lakes, FL 34639
********@*****.***
Professional Summary
Dynamic, enthusiastic and well-trained professional with a sixteen year leadership background in the health and the human services environment. Seeking a management or individual contributor role that will allow me to utilize my experience to maximize organizational expectations. A proven track record for getting results through effective communication, investigative problem solving skills and ability building strong relationships to ensure an immediate impact for organizational growth.
Education
Master of Divinity Liberty University, Lynchburg, VA 2010-2014
Bachelor of Science Business Administration, Argosy University, Tampa, FL 2006-2008
Associates of Arts in Pre-Pharmacy, St. Petersburg College, St. Petersburg, FL 2003-2004
Certified Pharmacy Technician, Pharmacy Technician Certification Board (PTCB) Certificate
Core competencies include:
Account Management/ Contract Management
Quantitative and Qualitative Analysis
Data Mining
Training Facilitator and Presenter
Professional Experience
Strayer University- Tampa, FL 06/2014-present
Adjunct Professor of World Religions
Provide lecture experience for undergraduate class of 18-35 students in order to bridge scholarly material to real-life implementation
Collegial duties of teaching scholarly research process to be transferrable to business environment
Conduct course need assessments and analysis of course evaluations to measure transference of class knowledge for institutional growth
Assist students in scholarly writing, development, and maintenance of course materials, lesson plans, and practice exercises
Utilize religious studies to enhance student appreciation and respect for cultural differences in the workplace and community
Developed Course Curriculum under collaboration with Department Chair and Campus Deans
Manage classroom setting of bi-vocational students
MetLife-Tampa, FL 05/2013-present
Implementation Manager/LTC Claim Analyst
Oversees Team that performs analysis of Long Term Care Policies to include payment rate and benefit eligibility based on medical diagnoses.
Identify fraud, waste and abuse on LTC Claims.
Maintain relationships with LTC Providers and Facilities to determine eligibility and financial documents for policy holders.
Train, communicate and coordinate process improvement methodologies for department.
Serve on Department Forms Committee to improve formatting and operational effectiveness of all internal and outgoing business forms
Liaison between client and internal and external organizations to include Brokerages, General Agents and Vendors
SME on Life cycle of Implementation Case Setup for Broker Configuration and Internal Agent Contracting
Insure Department Audit reflects 100 % of Enrollment Census are clean for Group Coverage Implementations
Project Management Lead on Customer and Broker Implementation Process
Davis, pg. 2
United States Army Reserve 08/2009 – Present
Rank: Captain/Occupation: Chaplaincy
Active member of the commander's special staff (i.e. Senior Advisor to the commander)
Supervise 300 soldiers and provide support in matters pertaining to missions and everyday soldier activities.
Safeguard privileged communications, reports, files, and administrative data for critical operations.
Through Traumatic Event Management responsible for guiding the well-being of soldiers, their families and the Unit Command.
Responsible for Special Internal Investigations in conjunction with finance and personnel staff reportable to Unit Commander
Conduct Trainings and Diversity Surveys to ensure religious and ethical program of unit services the whole constituency.
Serve as holistic adviser to military line leaders on overall company morale which includes racial, orientation and religious legalities.
Determine Management Styles and effects of implementation on staff and Soldiers’ morale.
Universal Healthcare- St. Petersburg, FL 12/2012-04/2013
Sr. Compliance Analyst
Reported to Chief Compliance Officer
Reviewed and report 10 Medicare files weekly to Center for Medicaid and Medicare Services (CMS).
Provided root cause analysis of investigate allegations against multinational health plan ensuring compliance to federal regulators and guidelines; correct payment of claims, fair & truthful marketing practice and accessibility to services.
Investigated Marketing Misrepresentation Allegations against sales agents to ensure resolution and improved processes were implemented.
Provided feedback and guidance to all departments within the company
Developed and Implemented Performance Improvement Plans
WellCare -Tampa, FL, 11/2005 – 11/2012
Pharmacy Technician/Appeals & Grievance
Logged, tracked, and processed from receipt to resolution 20 plus Health Service Appeals per day for a multi-million nationwide membership focusing on government-sponsored health care programs.
Achieved the top five percent (5%) award in productivity out of 150 in the department.
Conducted general appeals and grievance research and drew valid conclusions consistent with policy and procedures for more than ten medical insurance contracts to include: policy exclusions, reimbursement rates, compliance standards and root cause analysis.
Elected Roundtable Representative reporting bi-weekly to the Sr. Director of Pharmacy in order to present solutions related to workflow process and employee relations.
Resolved 20 plus Expedited Grievances weekly and reported to states of Florida, Ohio, and Illinois Departments of Insurance regarding; Quality of Care, Ancillary, Access to Care, Case Management, Network Development, Provider Relations, Utilization Management and Pharmacy Processing issues.
Walgreens Pharmacy- Tampa, FL, 10/1995 – 11/2005
Supervisor Pharmacy Technician
Supervised five technicians within team and worked under the senior management of a pharmacist.
Handled 40-50 phone inquiries per day, resolved processing issues for insurance companies and third party administrators regarding electronic policy overrides for medication, member eligibility issues and therapeutic dosage increases.
Supervised $3 million inventory of prescription drugs and processed specialty item orders from external vendors.
Ten years practical work experience in a claims, customer service, and health services environment.
Led team of technicians and served as liaison for District Management from Retail Pharmacy setting
Software Knowledge
MS Office – Expert, Walgreen Health Initiative System Navigator, Medical Terminology literate
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