Qiana Shaw

Serve as resource or Subject Matter Expert (SME) to other team members or internal customers.

• Handle escalated calls, resolving more complex customer issues in a one and done manner.
• Answer incoming calls from our customers on issued related to benefits eligibility questions and prescription status inquiries.
• Help guide and educate customers on their prescription benefits, use of plan, formulary, premiums, and status of order, and claims or inquiries.
• Ask appropriate questions and listen actively to identify any questions or issues while documenting required information in computer systems.
• Identify issues and communicate solutions and steps to customers, pharmacies, and physicians with prescription orders and reorders.
• Escalate drug related calls as appropriate to licensed pharmacist for resolution.
• Coordinate internal resolution of claims exceptions and other issues to include determining appropriateness of overriding pharmacy claims edits and error messages.
• Make outbound calls to customers on prescriptions withhold orders and payments issue.
• May also assist with entering new prescriptions order into system.
• Meet performance goals established for position in area of efficiency, call quality, customer satisfactions, first call resolution and attendance.

• Outbound telephone communication in professional manner and according to productivity and quality standards.
• Process outbound data and communication (i.e. faxes, emails, and electronic communication) according to productivity and quality standards.
• Enter, review and or verify member information in Navi Health Coordinator care management platform and communicate approved pertinent information with healthcare providers and/or Navi Health team as needed.
• Enter required data into Navi Health database accurately and in timely manner.
• Complete administrative documentation for member records including but not limited to transitioning, creating authorization shells, and attaching documents (i.e. medical records).
• Perform other duties and responsibilities as required, assigned, and requested.

• Keeps accurate accounting of cash, credit transactions, and check payments
• Balanced revenue sources along with balance property accounts with completing daily financial reports
• Microsoft Excel (ability to create, edit, save and update spreadsheet), Microsoft
• Workbooks (ability to create, edit, save and send documents), Microsoft Outlook (ability to send / receive emails and attachments), and Access to submit reports to corporate office as appropriate.
• Completed night audit for guest ledgers to close bank and cash registers, reconciling issues quickly, and marking discrepancies.

• Answer incoming phones calls from service members and identify what type of assistance is need by service member’s needs
• Resource Queue - Serves as Subject Matter Expert by answering questions and accepting escalated calls from team member
• Coordinated patient appointments and scheduling to promote optimal clinician productivity and patient satisfaction.
• 4+ years of Optum Serve experience.
• 2+ years of experience with MedNet or Webapp.
• 2+ years of experience with Mitel, internal queues or external queues.
• 4+ years of experience with Microsoft Office programs; Word, Excel, PowerPoint, and Outlook.