Customer Service Care
Resume:
Schiavone Taylor
Franklin, VA *****
****************@*****.***
Work Experience
Customer Care Representative
Sedgwick
August 2024 to February 2025
• Handles customer inquiries and assists with claims processing, ensuring excellent customer service and efficient claims management
• Answer phone calls, respond to written inquiries, and provide updates on claims status
• Assist with entering information into the claims management system, ensuring accuracy and completeness
• Inform claimants about the necessary documentation, timelines, and payment information
• Help customers resolve issues related to the claims application process and service Member Service Representative
Prime Therapeutics
September 2023 to December 2024
• Provided real-time claims adjudication, increasing process efficiency
• Engaged with Members, Caregivers, Providers, Pharmacies and Third parties regarding pharmacy benefits.
• Assisted with escalated benefit issues or questions, ensuring timely resolution and clear communication.
• Evaluated benefit plan design options to ensure cost effectiveness and competitiveness in marketplace.
• Provided excellent customer service while addressing patient inquiries about authorization process.
• Coordinated with pharmacists to ensure medications were prescribed within formulary guidelines.
• Resolved issues related to denied authorizations by providing additional information or appealing decisions.
• Updated provider directories regularly to maintain accurate information about network participation status.
• Assisted patients with understanding their insurance benefits and financial responsibilities.
• Submitted prior authorization requests through online portals, fax, or phone calls.
• Ensured compliance with HIPAA regulations regarding patient privacy and security measures.
• Maintained accurate records of all prior authorization submissions in database system.
• Collaborated with healthcare providers to obtain required clinical information for approvals.
• Reviewed medical records and gathered necessary documentation for prior authorization requests.
• Reviewed written correspondence, gathering information and formulating accurate and appropriate responses.
Pharmacy Care Specialist
Select Rx
April 2022 to September 2023
• Answered incoming calls from patients, caregivers, physicians, hospitals, and referral sources/affiliated partners and respond to questions while researching required information and using all available resources
• Answered patients' questions/concerns regarding their medications and refer to a pharmacist where needed
• Followed-up with customers or expediting calls to the appropriate channels
• Made outbound calls to physician offices to obtain prescription clarifications, refill authorizations, prior authorizations, and medication profiles
• Properly communicated with patients, healthcare providers, and payers regarding any medication requests, additional information needs, or potential billing challenges
• Provided patients with order status updates (fulfillment & delivery), proof of deliveries, insurance verifications, and price quotes/copay information
• Managed 80-100 daily customer interactions, ensuring accurate medication info and follow-ups.
• Delivered empathetic, compassionate and person-centered care to all patients. Medical Service Coordinator
Pearl Interactive Network
September 2021 to January 2022
• Implemented timely scheduling of COVID-19 tests and vaccines, enhancing patient care
• Managed seamless operations through patient check-in, co-payment processing, and referral verification
• Assured accuracy in data management and medical records keeping
• Promoted patient safety and clinic efficiency via health safety measures coordination. Chat Technical Representative/Work From Home
Kelly Services
December 2018 to September 2021
• Balanced call center workload by assisting with email and live chat support
• Streamlined issue resolution, improving customer experience
• Documented customer interactions meticulously, enabling effective future reference
• Demonstrated product features digitally, boosting customer product knowledge
• Promoted to Senior Advisor, reflecting outstanding performance and leadership. Education
Bachelor's in Sociology
Southern New Hampshire University - Manchester, NH September 2016 to December 2018
Bachelor of Arts in Sociology
Elizabeth City State University - Elizabeth City, NC August 2011 to May 2015
High School Diploma
Franklin High School - Franklin, VA
September 2008 to June 2011
Skills
• HIPAA
• Communication skills
• Organizational skills
• Insurance Verification
• Benefits Administration
• Phone etiquette
• Customer service
Certifications and Licenses
Driver's License
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