Customer Service Specialist - Pharmacy/Healthcare

Shaniqua Turner

Mansfield, TX ***** 945-***-**** ***************@*****.***

Target Role

Customer Service Representative Member Services Customer Advocate (Pharmacy / Healthcare) Summary

Pharmacy and healthcare customer service professional supporting members through phone, email, and chat in fast-paced contact center environments. Strong in active listening, empathy-driven service, de-escalation, benefits/claims research, and accurate documentation while following HIPAA and confidentiality standards. Comfortable navigating multiple systems, escalating complex issues, and staying reliable on schedule with quality-focused work. Core Skills

Calls, email, and chat support • Customer advocacy and active listening • De-escalation and complaint resolution • Benefits & eligibility • Claims status research • Provider network/coverage questions • Pharmacy claims support and paid-claim follow-through • Prior authorization (PA) status/requirements support • Mail-order pharmacy support • Prescription refills and order status • Clear documentation and recordkeeping (HIPAA/confidentiality) • Escalations and cross-team coordination • Quality focus (QA/AHT awareness) • Schedule adherence and attendance reliability • Multi-system navigation

Professional Experience

Virtuoso Sourcing Group — Customer Service Associate May 2025 – Nov 2025

• Handled inbound customer inquiries across phone, email, and chat; confirmed details, clarified issues, and set expectations.

• Resolved complaints and account concerns (orders, shipments, returns, payments) and escalated complex issues to the right channel.

• Provided Tier 1 technical troubleshooting and documented actions/outcomes clearly to support follow-up and consistency.

• Worked in high-volume queues while maintaining professionalism, quality standards, and schedule adherence. Cerpass Pharmacy — Customer Service Associate (Remote) Sep 2024 – Feb 2025

• Assisted with pharmacy claim processing to help obtain paid claims and reduce delays for customers.

• Managed high call volume (about 100/day) and handled escalations using calm de-escalation and clear communication.

• Captured accurate notes, provided next steps, and coordinated with pharmacy staff on claim status and missing information.

CarelonRx, Elevance Health — Customer Service Representative (Remote) Oct 2023 – Apr 2024

• Supported members with benefits, eligibility, claims status, coverage, and provider/network questions across multiple systems.

• Researched account details, explained options in plain language, and protected sensitive member information.

• Assisted with prior authorization (PA) questions by checking status/requirements and routing to the correct team; documented outcomes.

Humana (Mail Order Pharmacy) — Customer Service Representative Sep 2019 – May 2020

• Supported prescription refills, medication order status, and medication history requests via phone, email, and chat.

• Answered benefit/eligibility questions, updated patient profiles accurately, and routed issues for resolution when needed.

Anthem, Inc — Customer Service Representative Feb 2019 – Aug 2019

• Handled benefits, eligibility, provider, and claims inquiries via phone and written correspondence; researched issues and documented updates.

Education

Bryan University — Pharmacy Technician Program Completed Oct 2025 (state board exam pending) Relevant training: prior authorization (PA) basics; insurance/prescription billing workflows; HIPAA and confidentiality South Oak Cliff High School — Diploma 1998

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