Operation Customer Expert/prior authorization/insurance verification

I have experience in insurance verification where I was responsible for checking and confirming patients’ insurance coverage, eligibility, benefits, and policy details before services were provided. My tasks included contacting insurance providers, reviewing member accounts, verifying copays, deductibles, and prior authorization requirements, and ensuring all information was accurate in the system. I also handled follow-ups for pending verifications, resolved discrepancies, and coordinated with internal teams to avoid claim denials or delays. This role helped me develop strong attention to detail, communication skills, problem-solving abilities, and a solid understanding of healthcare insurance processes

Worked as a Customer Support Representative in a healthcare insurance account handling member and provider concerns regarding eligibility, benefits, claims, prescription drug plans, prior authorization, and insurance verification. Assisted customers through inbound and outbound calls while ensuring accurate documentation and resolution of issues. Experienced in handling escalations, follow-ups, and coordinating with different departments to provide timely updates and quality customer service. Maintained HIPAA compliance and protected confidential patient information at all times.

I have experience handling prior authorization requests under a Prescription Drug Plan (PDP), where I was responsible for securing insurance approval for medications that required coverage review before they could be dispensed. My tasks included reviewing member eligibility, checking formulary requirements, determining if prior authorization, step therapy, or quantity limits applied, and coordinating with prescribers to obtain the necessary clinical documentation. I submitted requests through insurance portals, fax, or phone, and closely monitored cases for status updates, approvals, denials, or additional information requests. I also handled follow-ups and escalations for urgent medication needs, communicated outcomes to pharmacies, providers, and members, and ensured all case notes were accurately documented. This experience strengthened my knowledge of Medicare and commercial prescription drug plans, medication coverage policies, and the importance of timely processing to avoid delays in patient care.