Pharmacy Technician Customer Service
Resume:
A B O U T M E
ERICKA N. JONES
GRIEVANCE & APPEAL COORDINATOR
SUMMARY OF QUALIFICATIONS
To obtain a position which effectively manages the grievance and appeal process for a top-tier insurance provider. Skilled Customer Service professional adept at resolving issues. Experienced Pharmacy Technician skilled medication dispensing in both hospital and retail settings. EXPERIENCE
GRIEVANCE AND APPEAL COORDINATOR
12/2008 – 12/2011
Managed analysis, evaluation, resolution and response to customer complaints (grievances) regarding service received from medical and pharmaceutical providers as well as rejected claims and services
(appeals.) Conducted internal and external research as appropriate to address grievance and appeal cases for subscribers and providers. Processed appeals and grievances in accordance with established deadlines.
AUDIT ANALYST
7/2006 – 12/2008
Responsible for coordination and implementation of projects at a divisional and corporate level involving efforts to increase efficiency of operational procedures, controls and performance. Providing analysis, processing and expediting of high priority operational transactions including but not limited to dispute resolution. Participation in system testing as well as development of internal procedures and internal controls to ensure data security and integrity. Responsible for direct communication with internal and external customers PHARMACY TECHNICIAN
09/2004 – 07/2006
Analyzed and evaluated pharmacy and physician inquiries received via telephone regarding commercial and Medicare D pharmacy benefits, prior authorizations, step care therapy, on-line prescription claims and claim rejects.
CUSTOMER SERVICE REPRESENTATIVE
07/2001 – 09/2004
Responsible for addressing and resolving customer inquiries received by telephone involving a variety of claim and benefit issues. SKILLS
Grievance & Appeals
Coordinator with 10+ years of
experience working for a
Top-Tier insurance company
C O N T A C T
**********@*****.***
19230 Mackay
Detroit MI 48234
E D U C A T I O N
WAYNE COUNTY COMMUNITY
COLLEGE
Liberal Arts Coursework
2001
CROCKETT ADULT EDUCATION
Pharmacy Technician
Certificate
1996
Appeal & Grievance Administration
Research and Analysis
Customer Service
Data Entry
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