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Jessica Pugh

@jessicapugh

Healthcare and customer experience professional with 14 years of experience supporting members, patients, and providers through complex processes with

Portugal

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What I'm looking for

I'm seeking a remote position focused on data entry, claims processing, or claims resolution where I can apply my experience reviewing claims, researching discrepancies, maintaining accurate records, and resolving account issues. I’m especially interested in detail-oriented, process-driven roles where I can work independently while ensuring accuracy and timely completion of assigned work.

I am a customer-focused professional with 14 years of experience across healthcare operations, customer support, claims management, intake coordination, and relationship building. Throughout my career, I have been passionate about helping people navigate complex processes while ensuring they feel supported, informed, and cared for.

My background includes working with organizations such as Humana Healthcare, Centene Corporation, BayRidge Effective Therapy, and independent healthcare practices. I have experience managing insurance verification, prior authorizations, claims research, member services, patient onboarding, scheduling, referral coordination, and community outreach. I am comfortable working in high-volume environments, handling sensitive information, and balancing multiple priorities while maintaining accuracy and exceptional service standards.

In my current roles, I support healthcare providers and clients through intake, insurance processes, scheduling, and ongoing communication. I also build professional relationships with referral partners, physicians, schools, wellness organizations, and community resources to expand access to care.

I thrive in remote environments and enjoy roles that combine problem solving, relationship management, organization, and meaningful customer interactions. I am proficient with CRM systems including Salesforce and Zendesk, Microsoft Office, Google Workspace, and various healthcare platforms. I am known for being dependable, detail-oriented, adaptable, and someone who takes ownership of their work.

Outside of work, I enjoy traveling, exploring new cultures, learning about technology and data analysis, cooking, hiking, and spending time with my dog, Kiki. I am always looking for opportunities to continue growing professionally while contributing to organizations that value collaboration, empathy, and excellent customer experiences.

Experience

Work history, roles, and key accomplishments

Current

Virtual Office/Care Coordinator

Current

Massage Mobile

Apr 2026 - Present (6 months)

Managed referral intake, insurance verification, and patient onboarding for 2–10 new patients weekly. Scheduled appointments for a team of 5+ practitioners and maintained patient records and billing accuracy using JaneApp and Microsoft Teams tools.

Referral Intake Management Data Entry Insurance Verification Patient Onboarding Appointment Scheduling Patient Record Management Billing Accuracy Microsoft Teams Microsoft Planner Microsoft Shifts Jane App

Current

Referral & Outreach Coordinator

Current

Bayridge Effective Therapy

Feb 2026 - Present (8 months)

Built and managed a structured healthcare referral pipeline across California partners and community organizations. Conducted outreach, scheduled introductory calls, and tracked follow-ups and partnership metrics using spreadsheets and reporting dashboards.

Follow Up Cadences Referral Pipeline Management Outreach via Email Phone Outreach LinkedIn Outreach Scheduling Introductory Calls Follow up Cadences Data Tracking Shared Spreadsheets Reporting Dashboards Community Engagement Outreach

Prior Authorization Specialist

Centene Corporation

Nov 2024 - Nov 2025 (1 year)

Triaged prior authorization and coverage determination requests submitted by providers and coordinated pharmacist review when required. Collected clinical information for authorization decisions, entered outcomes into a PBM system, and notified providers and members.

Prior Authorizations Coverage Determination Triage Clinical Information Collection Verbal Authorization PBM Systems Member Communication Specialty Drug Referral Authorization Status Updates Provider communication

Failed Claims Analyst

Humana Insurance

Apr 2021 - Jul 2024 (3 years 3 months)

Analyzed and resolved high volumes of failed prescription insurance claims to reduce future denials. Assessed eligibility and medical necessity using EPOST, Argus, and CRM systems while ensuring compliance with payer policies and billing regulations.

Workflow prioritization Failed Claims Analysis Claim Eligibility Assessment Medical Necessity Review EPOST Argus CRM Systems Insurance Policy Research Payer Policy Compliance

Clinical Services Pharmacy Technician

Clinical Services Pharmacy

Jan 2020 - Apr 2021 (1 year 3 months)

Provided remote customer service by addressing account management and benefit information inquiries. Communicated service utilization policies and procedures and maintained timely, accurate support for customer needs.

Customer Service Account Management Benefit Information Support Remote Support Policy Communications

Lead Pharmacy Technician

Mayfield Pharmacy

May 2012 - Jan 2020 (7 years 8 months)

Provided customer service support to patients and healthcare providers while building expertise in insurance practices. Performed billing checks and audits and helped onboard and train new staff to improve operational efficiency.

Billing Audit Corporate Trainer Pharmacy Customer Service Insurance Practices Billing Checks Staff Onboarding Problem Solving

Cash Office Manager

Marshalls

Mar 2011 - May 2012 (1 year 2 months)

Managed financial transactions with high accuracy to minimize cash discrepancies and ensure integrity of cash management procedures. Produced financial reports and maintained meticulous records of cash and credit transactions.

Record keeping Cash Management Financial Transaction Handling Cash Discrepancy Minimization Financial Reporting Cash and Credit Reconciliation

Enrollment Specialist

Circle of Success

Dec 2025 - Present (10 months)

Handled high-volume outreach to webinar-generated leads and supported prospective clients through enrollment and financing. Managed lead status updates in Google Sheets and coordinated onboarding steps including required forms and autopay setup.