Molly Caldwell
Tempe,AZ
Summary
A dedicated and empathetic patient advocate. Experience in verifying patient eligibility, test claim adjudication, advising when coordination of benefits is needed, identifying patient estimated out of pocket costs. Experienced in the preparation, submission, and follow up of payer authorization requests. Strong ability to multi-task in a fast-paced environment. Excellent written and verbal communication skills, able to collaborate successfully with multiple points of contact and departments, as needed. Strive to contribute to the overall success of the Team.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Member/Patient Advocate
Tek Systems Temporary Agency
03.2025 - Current
- Assisted members and patients in enrolling in manufacturer copay assistance, patient assistance programs and foundations, documenting all information accurately.
- Verified Insurance Benefits and advised members/patients if a prior authorization is needed.
- Entered overrides in the Pharmacy Benefit Manager, for approved medications, and assisted pharmacies in processing claims.
- Communicated details of prior authorization approvals to the patient and pharmacy.
- Created new accounts, answered phones in a high call volume call center, utilized various procedure documents, and various CRM software, working on multiple platforms.
- Not a permanent position
Medical Claims Specialist/Adjuster
State Farm
03.2024 - 02.2025
- Managed and processed medical insurance claims efficiently, ensuring compliance with company guidelines.
- Analyzed medical records, verifying policy coverage and determining claim payments.
- Conducted in-depth investigations of potential fraud or inconsistencies, collaborating with internal teams to resolve discrepancies.
- Maintained thorough documentation and ensured adherence to regulatory requirements.
- Fostered clear communication with policyholders, healthcare providers, and stakeholders to streamline claims processing.
Medical Insurance Case Manager
McKesson Corporation
01.2019 - 01.2023
- Performed benefit verification of all patient insurance plans, documented coverage of medications and coverage of the medical administration costs.
- Documented all information related to coinsurance, copay, deductibles and advised prior authorization and appeal requirements.
- Reviewed patient financial documents to determine eligibility in enrolling in foundations and patient assistance programs.
- Operated multiple technical platforms to manage complex tasks and maintain accurate patient records.
Sales Representative
Dexcom (via Aerotek)
01.2018 - 01.2019
- Addressed customer inquiries, resolving product/service concerns related to the Dexcom glucose monitor.
- Performed benefit verification of all patients insurance plans and educated patients on their benefits and out-of-pocket costs.
- Collaborated with my Territory Manager in acquiring prescriptions and supportive documentation from providers for insurance authorization purposes.
- Managed customer relationships professionally and empathetically, educating them of the insurance process to acquire coverage of the Dexcom glucose monitor.
Health & Life Insurance Agent
Humana
01.2017 - 01.2018
- Assessed client needs to provide tailored insurance solutions that aligned with long-term health goals.
- Responded to customer inquiries, offering insights into health insurance coverage and policy details.
- Negotiated contract terms and maintained accurate records of customer interactions in line with regulations.
- Stayed updated on changes in health insurance laws to ensure clients were receiving current, accurate information.
Rx Insurance Education and Prior Authorization Specialist
Humana
01.2011 - 01.2017
- Educated members on their medical and pharmacy insurance benefits
- Collaborated with healthcare providers in submitting supportive medical documentation for review.
- Processed and submitted prior authorization requests, communicated with patients and providers on the status of the requests.
- Ensured timely resolution of denied or delayed authorizations by identifying and addressing issues.
- Stayed informed on HIPAA regulations and operated accordingly.
Education
Pharmacy Technician -
Apollo College
Spokane, WASkills
- Technical Skills: Microsoft Office Suite, Microsoft Word, Microsoft Outlook, Teams
- Systems: Salesforce, Accurint, AMR/ISO, Custom Company CRMs
- Additional Skills: Insurance Verification, HIPAA Regulatory Compliance, Accurate documentation & recordkeeping, knowledge of ICD-9 ICD-10 and CPT Codes, Ability to work in a fast paced environment effectively, Empathetic Customer Communication, Knowledge of enrolling patients in Manufacturer Copay Assistance, Patient Assistance Programs and Foundations, Experience in running test claims for adjudication
Certification
- Arizona Health & Life Insurance License | License # VA00049723 | Expired. 2018-06-29
- Pharmacy Technician Certification | # 14767247 | Expired.
Timeline
Member/Patient Advocate
Tek Systems Temporary Agency
03.2025 - Current
Medical Claims Specialist/Adjuster
State Farm
03.2024 - 02.2025
Medical Insurance Case Manager
McKesson Corporation
01.2019 - 01.2023
Sales Representative
Dexcom (via Aerotek)
01.2018 - 01.2019
Health & Life Insurance Agent
Humana
01.2017 - 01.2018
Rx Insurance Education and Prior Authorization Specialist
Humana
01.2011 - 01.2017
Pharmacy Technician -
Apollo College