Case Manager Customer Service
Resume:
Lori Waddell
Bristol, VA *****
**********@*****.***
Professional Summary
I am an enthusiastic, self-motivated, reliable, responsible and hardworking person. I am a mature team worker and adaptable to all challenging situations. I am able to work well both in a team environment and using my own initiative. I work well under pressure and adhere to strict deadlines. I am very willing to learn and develop new skills.
Authorized to work in the US for any employer
Work Experience
Case Manager
Eversana Life Science Services-Missouri
January 2025 to Present
I was hired for a contract position as a Case Manager with Eversana Life Sciences for our client Galderma. I completed 3 weeks of virtual training as well as 3 weeks of job shadowing for this position. I have gained experience in ACTICS, Pioneer RX, ultipro/UHR etc. I also currently possess an out of state Pharmacy Tech license from the state of Missouri. The anticipated end date for this contract position is March 31st 2025. Customer Service Representative
Luminare Health Benefits-Bristol, VA
April 2023 to December 2024
I provide Medical Insurance coverage verification, claim payment and claim denial information, insurance coverage details, co-pay, deductible, co-insurance and out of pocket details to member callers and callers from provider offices. I have experience adjudicating claims from start to finish. And experience in Medical billing and coding of almost 4 years. I also work with Medical Records daily. Coverage Determinations and Appeals Rep
CVS CAREMAK-Bristol, VA
October 2021 to March 2023
Verified insurance coverage for prescription medications, performed various Utilization Management exceptions to aid members in getting their medications. I was first to graduate from my training class, and was trained in 4 positions including as a Learning Advocate where I assisted in training new hires as well as provided aid to all employees with difficult cases or claims. I worked with medical records on a daily basis. I also worked closely with our HR department assisting with timesheets, job listings, interviews, training and other various tasks.
Remote Pharmacy Technician
Prime Therapeutics-Minnesota
May 2021 to August 2021
This was an assignment for Prime Therapeutics through Aerotek. My duties included 2 weeks of online training via WebEx and Cisco Jabber. Upon completion I processed patient prescriptions and ran test claims using multiple applications such as Cover My Meds, RXClaims, Confluence User Guide and Quantity Limit Grids. Giving me experience working in a remote setting while utilizing these various applications, as well as navigating multiple computer screens and various Microsoft Office applications such as Microsoft Word, Excel, Outlook and Power Point. As mentioned above, this job was an assignment through Aerotek that was not renewed.
Stay at Home Mom/College Student
Home-Bristol, VA
August 2015 to April 2021
I spent this time focusing on family and furthering my education. Two of my three children are now adults, my youngest is 13. Giving me more time to focus on my career. Caregiver
Department Of Social Services (DSS)-Bristol, VA
August 2014 to August 2015
I also attended CNA classes in my junior and senior years of high school. During these classes we often visited local nursing homes providing basic care to the residents. Including: helping them feed themselves or feeding them, helping them shave, bathe, brush their teeth, get dressed and even giving manicures to the female residents. I had a lot of interaction with many of the residents and got along well with everyone.
In Home Child Care
Department Of Social Services (DSS)-Bristol, VA
June 2013 to August 2014
I provided child care in my home for my neighbors’ son. I was certified through my local department of social services.
Stay at home mom
Home-Bristol, VA
April 2005 to July 2013
I spent this time focusing on family
Cashier/Customer Service
Walmart-Bristol, TN
October 2004 to April 2005
I worked as a cashier and in customer service while pregnant with my daughter. I had to quit due to pregnancy related medical issues. Once I gave birth these issues went away. Education
Bachelor's in Health Services Management
Independence University - Salt Lake City, UT
April 2016 to March 2019
Skills
• Caregiving
• Excellent communication skills
• Typing
• Excellent negotiation skills
• Microsoft Office
• Microsoft Excel
• Excellent problem-solving skills
• Dependable
• Pharmacy Technician Experience
• Customer service
• Writing Skills
• Nursing
• Microsoft Word
• Medicare Part D (10+ years)
• Time Management
• Meal Preparation
• Excellent computer skills
• Sales
• Utilization Management
• Makeup Application
• Medical terminology
• Windows
• HIPAA
• Pulmonary Coding Internal and Family Care Coding (4 years)
• iOS
• Confluence
Certifications and Licenses
Driver's License
BC/BE
Additional Information
Achievements :
1. Graduated first in my training class at CVS Caremark. 2. Certified in 4 positions at CVS Caremark.
3. Became a Learning Advocate and trained new hires. 4. Completed many management e-learning courses.
5. Obtained CPR and First Aide Certification.
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