Customer Service Regulatory Compliance
Resume:
J A N AYA
ROBY
B A NKS
**********@*****.***
Indianapolis, IN 46214
SKILLS
• Healthcare Customer Support. • Insurance & Claims Processing
• CRM & Case Management Systems • Cross-Functional Communication. Regulatory Compliance (HIPAA,
GCP, CMS)
• Problem Resolution & Escalation
Management.
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• Analytical and critical thinking • Excellent communication PROFESSIONAL SUMMARY
Dedicated and results-driven customer service professional with extensive experience in healthcare, pharmacy benefit management, and clinical trial support. Proven expertise in resolving complex patient inquiries, processing medical claims, and coordinating with cross-functional teams to ensure service excellence and regulatory compliance. Adept at navigating high- volume environments with professionalism, empathy, and precision. Skilled in CRM systems, HIPAA compliance, insurance verification, and problem resolution—consistently driving improvements in customer satisfaction, operational efficiency, and team performance.
EXPERIENCE
Investigator Support Coordinator, Labcorp/Covance Central Labs, May 2012 - May 2022, Indianapolis, IN
Coordinated end-to-end investigator support for global clinical trial sites, ensuring accurate lab kit delivery, protocol adherence, and rapid issue resolution in alignment with ICH-GCP and Labcorp SOPs.
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Liaised between clinical investigators, project managers, and internal lab teams to proactively address site inquiries, track sample logistics, and maintain protocol compliance across multiple therapeutic areas.
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Managed high-priority escalations from investigative sites, using Labcorp issue tracking systems and root cause analysis to deliver timely resolutions, improve site satisfaction, and uphold trial integrity.
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Trained new site coordinators and study teams on investigator support tools, sample collection procedures, and data entry standards, improving onboarding efficiency and reducing support requests by 30%.
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Monitored support metrics and investigator feedback to identify trends, implement process improvements, and drive continuous quality enhancements in line with sponsor expectations and regulatory compliance.
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Medical Claims Processor, Labcorp/Covance Central Labs, Sep 2010 - May 2012, Indianapolis, IN
Processed high-volume medical and laboratory claims with 99% accuracy using payer-specific guidelines, CPT/ICD-10 coding, and Labcorp proprietary billing systems to ensure timely reimbursement and compliance with federal and commercial insurance regulations.
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Analyzed Explanation of Benefits (EOBs), denials, and remittance advices to identify root causes of payment delays and initiated corrective actions, resulting in a 25% reduction in claim rejections over a 6-month period.
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Collaborated with cross-functional teams—including clinical operations, revenue cycle, and customer service—to resolve complex billing discrepancies and improve first-pass claim resolution rates.
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Led internal audits of claims documentation and coding accuracy, training new processors on Labcorp standard operating procedures and CMS compliance requirements, contributing to enhanced team performance and audit readiness.
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Communicated directly with payers and third-party administrators to appeal denied claims, negotiate resolutions, and uphold patient financial advocacy, reinforcing Labcorp commitment to service excellence and operational efficiency.
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Customer Care Representative III, Express Scripts/Precision Rx Specialty Solutions, Apr 2007 - Sep 2010, Indianapolis, IN
Resolved high-volume inbound inquiries (50+ daily) with empathy and precision, delivering personalized support for patients managing complex specialty medications, while adhering to HIPAA regulations and Express Scripts' service protocols.
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Coordinated cross-functional communication between patients, pharmacists, and insurance providers to streamline prior authorizations, benefit verification, and timely medication delivery—reducing delays by 35%.
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Led escalated service recovery initiatives by acting as the primary point of contact for sensitive cases, ensuring resolution within SLA parameters and boosting customer satisfaction ratings by 20% month-over-month.
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Utilized CRM systems (including Salesforce and proprietary Express Scripts platforms) to document interactions, identify trends, and escalate systemic issues to leadership for continuous service improvement.
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Educated patients and caregivers on medication adherence, refill scheduling, and specialty drug handling, enhancing therapeutic outcomes and supporting the organization's mission to improve patient well-being.
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EDUCATION
B.A.: Criminal Justice
Indiana University Northwest, Gary, IN, Jun 1997
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