Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary

Oncology, Endocrinology, Hematology experienced Field Reimbursement Manager with over 8 years of experience in reimbursement support of speciality injectable medications. Excellent reputation for resolving problems, improving customer satisfaction, and driving overall operational improvements.

  • Disease specialization proficiency Healthcare billing proficiency
  • B2B Sales, Pharma Sales 2+
  • Strong medical ethic Problem resolution ability
  • Oncology, Immunology, Endocrinology, Hematology and Transplant Reimbursement Support
  • Medicare Part A, B,C, D and Commercial payer knowledge
  • Speciality Pharmacy process and provider support
  • Hub Management and collaboration on reimbursement level
  • Self-motivated
  • Process implementation
  • Team liaison
  • Project manager supervision
  • Claims investigation and research
  • Speciality Pharmacy Billing
  • Project management
  • Effective communication skill
  • Relationship building
  • Stakeholder relations
  • Client account management
  • In-depth pharmacy law knowledge
  • Chronic disease management
  • Strong written and verbal communication skills
  • Works well independently
  • Effective at multi-tasking
  • Budget administration
  • Team building skills
  • Understanding of miscellaneous J-Code and Q code billing
  • Buy and Bill experience in all healthcare settings
  • Territory Management (Multiple State Coverage on six week rotation)
  • Self Starter, seeker of solutions and answers
  • Culture focused and dedicatoin
Work History
Field Reimbursement Manager , 10/2017 - Current
Covance Cleveland, OH,
  • Interacting with key stake holders within the specialty practice or hospital outpatient locations facilitating live training and education (group sizes vary)
  • 5+ years of experience with specialty providers in support of reimbursement
  • Reviewing patient insurance benefit options. Validating prior authorization requirements identifying alternate funding/financial assistance programs
  • Reviewing appropriate billing and coding for products. Assisting with resolving reimbursement issues
    Coordinating with client’s patient support services programs representatives
  • Educating physician office staff on the use of the client’s patient assistance and reimbursement support services including web based provider programs. Providing information on relevant reimbursement topics related to client’s products
  • Collaborated with team to define business requirements for organizational processes, achieve productivity standards and adhere to accuracy standards
  • Implemented brand and demand strategies to meet revenue targets for business services and products
  • Operated with high integrity, built trust, and earned sustained credibility with internal and external clientele
  • Developed and executed targeted relationship and account development strategy
  • Interpreted and communicated new or revised policies to staff.
  • Multiple State Coverage on a six week rotation
  • Oncology, Hematology,Endocrinology reimbursement support.
  • Buy and Bill Reimbursement Support
  • Sales and Marketing Support
  • Multipe New Product launch Support
  • Work with Sales personnel and managed market accounts finding solutions to address coverage and reimbursement barriers
  • Oncology Account Manager
  • Assisted in managed market training and ROE (Rules of Engagement ) implementation.
Senior Medical Review Team Lead , 11/2015 - 10/2017
Aetna SSI City, STATE,
  • First point of contact for Operation system issues for Medical Review Team
  • Provided detailed analyses of weekly and monthly team metric to Senior Leadership Team
  • Monitored and Audit team productivity at 100% Subject Matter Expert on making sure all team SOP are current and implemented
  • Entered details such as payments, account information and call logs into the computer system
  • Initiated two key partnerships which resulted in 54% revenue growth
  • Validated schematic designs working alongside hardware engineers
  • Verified data integrity and accuracy
  • Responded to customer requests via telephone and email
  • Analyzed departmental documents for appropriate distribution and filing
  • Copied, logged and scanned supporting documentation
  • Worked directly with Underwriting, New Business and Sales to achieve one call resolution
  • Evaluated quality problems and performed 100% audit to identify and resolve issues.
  • Identified and resolved process issues to encourage smoother procedures, more efficient workflow and overall business growth.
  • Supervised production planning while using appropriate tools and analysis for smooth production output.
  • Presented metric reporting and daily to Director on teams daily work load and time sensitive accounts.
  • Coordinated with Claims and New Business team in developing project plans for prioritized initiatives.
  • Developed standard operating procedures and document workflows for current and future process steps.
  • Developed team communications and information for weekly Monday team meetings.
  • Researched and compiled statistical data to support cost control and care improvement initiatives.
  • Kept accurate log of all requests for medical information and records.
  • Managed system conversion and maintained minimal downtime during updates.
  • Identified new methods to optimize medical records management.
  • Trained twenty direct reports on department procedures and policies to maximize department effectiveness.
  • Resolved conflicts and negotiated agreements between parties in order to reach win-win solutions to disagreements and clarify misunderstandings.
Senior Reimbursement Oncology Manager , 02/2013 - 10/2015
Novartis Pharmaceuticals, United BioSource Corporation City, STATE,
  • Served as first point of contact for internal clients and members during the enrollment process
  • Make outbound calls to members to gather Enrollment Data; analyze and process data accordingly
  • Handle inbound member calls and written correspondence regarding member eligibility Solved complex or critical member/client issues
  • Worked collaboratively with Eligibility Systems Analysts, other Eligibility Associates, Eligibility Managers and Account Managers to provide seamless support
  • Identify and escalate repetitive questions and /or problems so that corrective action can be pursued and expedited
  • Provided seamless updates to Key Account Holders and Program Manager bi weekly via conference call on metrics, pending request and trends
  • Utilized strong assessment skills to determine necessary patient care
  • Served as a liaison between patients and physicians to assist patients in understanding their treatment plans
  • Served as a key point of contact for agents, physicians and case managers on impending and pending issues or concerns
  • Served as a Project Manager on new product launch for Signifor LAR and re-branding Transplant Team
  • Managed high-value existing and new business partnerships to deliver on objectives and maximize corporate revenue, support and awareness.
  • Presented metric reporting bi-weekly on account reviews to Senior Leadership team and clients.
  • Conducted training and change management processes to improve operations.
  • Created and managed knowledge base to offer staff and customers immediate informational access to products, services and organization.
  • Analyzed current business plan, identified inefficiencies in existing processes, and tracked performance following implementation of improvements.
  • Closely collaborated with project members to identify and quickly address problems.
  • Communicated project plans and progress to key stakeholders, including project contributors, business, operational and technical resources.
  • Developed project plans identifying key issues, approaches and performance metrics.
  • Managed project elements for multiple initiatives from initial planning to project rollouts.
  • Transplantation Reimbursement Support, Lung, Kidney, Heart Novartis

MBA: Public Health, Expected in 04/2017
Strayer University - Memphis, TN ,
Bachelor of Arts: Mass Communication, English, Expected in 2010
Lane College - Jackson, TN,
Member of Mass Communication Club Coursework in Public Relation, Television Production, Photography, Public Speaking.
  • PCM (Professional Crisis Management) trained
  • Certified Aetna Technical Brand Writer

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School Attended

  • Strayer University
  • Lane College

Job Titles Held:

  • Field Reimbursement Manager
  • Senior Medical Review Team Lead
  • Senior Reimbursement Oncology Manager


  • MBA
  • Bachelor of Arts

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