Open to opportunities

Miracle Glover

@miracleglover

Message

I’m a pharmacy benefits specialist focused on accurate claims, authorizations, and HIPAA-compliant support.

United States

Message

What I'm looking for

I’m looking for a role where I can resolve pharmacy/insurance claim issues end-to-end, coordinate prior authorizations, and deliver HIPAA-compliant, high-quality patient and provider support—while using CRM documentation to drive accuracy and first-call resolution.

I’m a healthcare support and pharmacy benefits specialist with 3+ years of experience reviewing, troubleshooting, and resolving medical and pharmacy claims across major payors. I help ensure accurate adjudication by identifying claim discrepancies, updating member information, and maintaining quality in high-volume environments.

In my roles, I manage commercial accounts and handle complex pharmacy claim issues from intake through resolution. I investigate rejections, billing discrepancies, and eligibility concerns while staying fully HIPAA-compliant, and I coordinate prior authorizations, coverage determinations, and medication exception requests.

I’m skilled at clear, patient-friendly communication—explaining coverage topics like deductibles, coverage gaps, TROOP, and accumulators in digestible terms. I also support pharmacies, providers, and internal teams to troubleshoot issues quickly, reduce repeat inquiries, and maintain detailed CRM documentation for compliance and auditing.

I’m also experienced in insurance verification and insurance claims workflows, including processing payments, managing case notes, and navigating eligibility and benefit inquiries. I take pride in first-call resolution and proactive follow-up to keep care moving without avoidable delays.

Experience

Work history, roles, and key accomplishments

Pharmacy Benefit Specialist

Cigna

Sep 2025 - Jul 2026 (10 months)

Reviewed prescription claims for inconsistencies, coverage issues, and processing errors to ensure accurate adjudication. Managed commercial insurance accounts, handled claim rejections and eligibility concerns, and coordinated prior authorizations and medication exception requests while maintaining HIPAA compliance.

Insurance Verification Pharmacy Benefit Management Prior Authorizations Formulary Exception HIPAA compliance Commercial Insurance Eligibility Investigation

Patient Support Specialist

Everise – CVS

Nov 2024 - Sep 2025 (10 months)

Processed patient payments and resolved insurance claim errors while ensuring accurate insurance information before submitting claims via Athena billing software. Provided coverage/copay and EOB interpretation support, documented cases in EPIC CRM, and followed up on unresolved billing or claim issues with HIPAA compliance.

Insurance Claim Resolution EOB Interpretation HIPAA compliance

Pharmacy Benefit Manager

CVS Health

Aug 2023 - Sep 2024 (1 year 1 month)

Managed high-volume inbound calls, resolving Medicare prescription and billing issues with high first-call resolution. Submitted prior authorizations and tier exception requests, documented customer grievances in Salesforce (Compass), and maintained accurate CRM records in PeopleSafe while explaining Medicare components clearly.

Medicare Prescription and Billing Support Prior Authorizations First Call Resolution Inbound Calls PeopleSafe Medicare Deductible Coverage Gap and TROOP Accumulator Explanation

Patient Care Coordinator

Carenet Healthcare

Apr 2023 - Jan 2024 (9 months)

Conducted triage intakes for medical and behavioral health needs, ensuring accurate data entry and HIPAA compliance. Connected patients with appropriate support teams based on urgency and care level and assisted members with eligibility inquiries, benefit navigation, and non-emergency medical transportation for Medicaid.

Data Entry HIPAA compliance Patient Support Team Routing Eligibility Medicaid Non Emergency Medical Transportation Coordination