Adreanna Hurtado

This role requires communication skills, interpersonal skills, and problem solving. I assist as a liaison between providers and members to ensure access to medications and help them take advantage of their benefits.

Some further responsibilities include:

• Member Advocacy: Support members in understanding their pharmacy benefits and coverage options, as well as assist with any prescription related inquiries.

• Issue Resolution: Assist with claims, denials, prior authorizations, and appeals to ensure timely access to prescription medications.

• Coordination with Providers: Get in contact with doctors and pharmacies to help facilitate international processes or coverage options.

• Case Management: Manage and follow up on member cases in a timely manner for resolution and customer satisfaction.

• Confidentiality: Adhere to guidelines, like HIPAA, and maintain member confidentiality.

This role required strong communication skills, multitasking skills, and also knowledge of healthcare and pharmacy benefit plans. I would assist in overseeing operations related to customer service and issue resolution.

Some responsibilities include:

• Benefit Explanation: Educate members on plan benefits, formulary coverage, and potential cost-saving options.

• Customer Support: Address inbound calls from members, providers, or pharmacies regarding claims, Rx issues, and benefits.

• Performance Metrics: Meeting the call center goals that include graded calls entailing customer satisfaction and first-call resolutions.