Healthcare-focused Customer Service Specialist with 3+ years of experience in insurance benefits verification, pharmacy benefit processing, and claims support. Background includes handling a high-volume queue of 100+ member calls daily for a PBM/pharmacy benefits account (Optum RX), covering prescription benefit coverage, prior authorization, eligibility checks, and physician/provider coordination — all under strict HIPAA/PHI compliance standards.
Skilled at navigating insurance-style member portals, CRM/ticketing platforms, and payer systems to verify eligibility, resolve billing and payment discrepancies, and process refunds or account adjustments. Experienced in escalation management, routing complex claims and billing cases to the right specialized team while maintaining audit-ready documentation.
Known for accuracy, strong turnaround discipline, and clear, empathetic communication in fast-paced, deadline-driven environments. Seeking to bring proven benefit verification and claims support expertise to a role in insurance, healthcare administration, or reimbursement services.
