Orlando Thomas

Patient Care Advocate and Prior Authorization Rep with over 10 years of experience providing high-touch customer support within complex healthcare and pharmacy benefit environments. Resolved an average of ~40 daily inquiries regarding insurance eligibility and claims, maintaining high standards for accuracy and member satisfaction. Expert in utilizing proprietary CRM software for technical troubleshooting and data entry to ensure seamless continuity of care for thousands of members.

Skilled communicator experienced in bridging gaps between patients, providers, and insurance systems to streamline administrative workflows.

Patient Care Advocate at Express Scripts (2013-01 – Present)

• Manage high-volume phone support using CRM software to accurately update pharmacy benefit claims and ensure member eligibility.
• Compose and edit professional case communications using precise medical terminology to facilitate seamless evaluation and provide comprehensive email support for members.
• Resolved an average of ~40 daily inquiries regarding insurance eligibility and claims, maintaining high standards for accuracy and member satisfaction.
• Address complex customer inquiries and complaints with patience and compassion to ensure positive resolution and high satisfaction scores.
• Coordinate across departments to secure resources for effective problem resolution, improving overall account management and service delivery.
• Provided level 1 technical and functional support to resolve platform access issues for member portal access, web profile setup, and claim discrepancies, and troubleshooting system for pharmacy benefit members.
• Assist patients in creating web profiles so they can make informed decisions in their medical care.
• Successfully worked remotely for six years.

Bachelor of Arts in English – University of Missouri, Saint Louis