Modino Adams User

Managed inbound calls from members, providers, and pharmacies, effectively relaying detailed information on Medical, Vision, and Pharmacy benefits. Submitted Concierge Referrals, checked Prior Authorization statuses, and ensured accurate claims processing, addressing rejections and making outbound calls to resolve claim issues with payers.

Handled inbound calls from patients and providers, providing comprehensive benefit and prescription information. Advised patients on plan details, shipped medications, provided costs, and made outbound calls to pharmacies for proper overrides. Triaged medications to specialty pharmacies and guided callers to participating local pharmacies.

Successfully launched a new HUB program, advocating for patients and healthcare professionals across the US regarding insurance coverage, medical billing, and reimbursement processes. Delivered verification of benefits, reviewed prescriptions for triaging, and identified/reported Adverse Events. Provided Tier II support, assisting agents and handling escalated calls.

Processed billing payments for patients and established payment arrangements for delinquent balances. Explained Explanation of Benefits (EOBs) to patients and managed account balances, including writing off balances with manager approval.

Assisted borrowers with delinquency management to prevent homes from going into foreclosure. Processed mortgage payments and helped borrowers explore different options to make homeownership more affordable.

Completed comprehensive coursework covering core academic subjects and various electives. Successfully mastered the required curriculum for high school graduation.