Customer Service & Case Management Leader
Resume:
Jaylene Sauri
*************.*@*****.***
Phone: 520-***-****
SUMMARY OF QUALIFICATIONS
●Excellent Customer Service Skills and People Skills
●Strong decision making skills and the ability to perform well under stress.
●Necessary experience needed to lead and motivate a team to achieve company goals
●Strong Work Ethic, Self-Motivated, Detail Oriented
●Leadership and Management skills
EXPERIENCE
Client Stabilization Specialist, Community Bridges, Inc. Aug 2025 – Dec 2025
•Monitored clients every two hours, ensuring safety and well-being
•Distributed food and discarded expired items
•Provided linens and hygiene supplies to clients, improving comfort and sanitation standards
•Entered notes into HMIS and emailed updates to management daily, maintaining accurate client records
•Completed incident reports as needed, supporting compliance and risk management
•Cleaned common areas to maintain a safe and welcoming environment for all clients
Case Management :
•Met weekly with clients to check progress, provide support and additional resources if needed
•Case load size: 3-6 clients
Certified Pharmacy Technician, CVS Specialty Pharmacy (REMOTE) November 2021 – August 2022
●Maintain HIPAA compliances and guidelines
●Process incoming prescriptions for patients
●Fax and/or call Doctor’s Office for refills on prescriptions
●Verify prescription was written properly with correct quantity according to dosing instructions
●Submit clarification request when needed
Certified Pharmacy Technician, LanceSoft Inc (REMOTE) November 2020 – October 2021
●Maintain HIPAA compliances and guidelines
●Performs non-medical research including eligibility verification, COB, and benefits verification
●Maintain accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
●Approve services that do not require a medical review in accordance with the benefit plan
●Contact physician offices on the patients’ behalf
Processing Manager, Prescription Care LLC (REMOTE) June 2020 – October 2020
●Create and implement new processes
●Maintain HIPAA compliances and guidelines
●Participate in development calls
●Create application templates
●Map templates in companies proprietary software system
●Call pharmaceutical manufacturers on the patients’ behalf
●Contact physician offices on the patients’ behalf
●Create, process and package envelopes for patient and physicians office
●Gather supporting documents for manufacturer envelopes
●Handle escalated issues from patients
Certified Pharmacy Technician, Loyal Source Government Services Feb 2019 – April 2020
●Fill and batch medications for patients
●Fill automatic dispensing machines with proper medications
●Answer phone calls from providers regarding status of medications
●Assist with putting inventory in its proper location
●Remove outdated medications from shelves
●Alert procurement specialists of inventory issues
●Ensure that the right medication is dispensed or shipped to the right patient on time
Pharmacy Technician, DLH Solutions. Feb 2018 – July 2018
●Label medication for military veterans
●Met and exceeded set metrics
●Stock and maintain automatic dispensing machines
●Stock the A-frame dispenser
●Ensure that the right medication is shipped to the right patient on time
Pharmacy Technician, Walgreens Co. Aug 2017 – Feb 2018
●Process insurance and clear up third-party reject issues
●Accurately fill prescriptions as written
●Call Patients regarding issues or to remind medications are ready
●Stock Shelves with product and supplies
●Answer phone calls from providers and patients
Pharmacy Technician Extern, Veteran Affairs Hospital Dec 2016 – Feb 2017
●200 Hours of on the job training
●OUTPATIENT SETTING:
oPrepared labels for filling
oAssisted with Inventory and Pulled expired medications from Med Carousel
oPrepared medications to be filled
oPut away inventory orders daily
oFilled automatic dispensing robots as needed
oCleaned and organized storage room
●INPATIENT SETTING:
oPrepared anesthesia trays for Operating Rooms
oPulled and prepared missed dosages for patients
oPulled and prepared First Fill dosages for patients
Customer Care Advocate, OptumRx Nov 2014 – Dec 2016
●Assist members with placing refills, paying balances on their account, and providing order status.
●Assist in providing plan benefit information as needed to callers while staying in compliance with HIPAA.
● Clarify billing questions the members may have.
●Proactively request prescriptions on member’s behalf.
●Explain policy benefits and verify coverage for providers,
●Assisted members with questions regarding there prescription coverage.
●Assist Prior Authorization with members requesting status or initiating a Prior Authorization.
Resolution Specialist Team Lead, Humana Jan 2013 – Oct 2014
●Research and resolve billing issues for associates, members, and employees.
●Trouble shoot technical issues, report/open tickets, web support, find/correct system defects/issues.
●Directly respond via phone, email, instant message, written correspondence, or face-to-face to resolve concerns and provide guidance on transactions, answer inquiries and complaints from both internal and external customers.
●Receive, document and resolve customer inquiries by using established best practices.
●Build lasting relationships with Humana’s customers and employees.
●Educate customers, providers, employers, and employees about Humana’s products and services both over the telephone and through face-to-face briefings.
●Miscellaneous process support for sister departments processing refill request, enter prior authorization request, and complete medical questionnaires, send denial/approval letter, and contacting providers.
●Assist Members, Provider’s Offices and Pharmacies with Prior Authorizations.
●Provide status checks when needed for members and providers. Assist with updating authorizations when applicable.
●Enter Faxes for Prior Authorizations accordingly.
Customer Contact Specialist - Customer Contact Channels Oct 2011 – Dec 2012
●Assisted members with placing refills, paying balances on their account, and providing order status.
●Assisted in providing plan benefit information as needed to callers while staying in compliance with HIPAA.
●Cross trained in Humana Billing & Enrollment Customer Service as well.
●Assisted members with billing and enrollment questions and issues.
●Arranged recurring payments, one-time payments and clarified billing questions the members may have.
●Explained policy benefits and verify coverage for providers,
●Assisted members with questions regarding there prescription coverage.
●Entered vacation and mail order overrides as needed.
Contact this candidate