Pamela Rivera- Green

Healthcare operations and compliance leader with 20+ years of experience in the health insurance and pharmacy benefit management (PBM) industry. Experienced in Medicaid and Medicare consulting, compliance auditing, claims oversight, enrollment reconciliation, and cross-functional team leadership. Recognized for improving operations, supporting regulatory compliance, and building strong client relationships.

Account Executive at MedImpact | Elixir Solutions | nvisionRx Options (2015-01 – 2018-12)

• Supervised daily operations and managed client issues and conflict resolution.
• Conducted monthly financial meetings, coordinated invoicing requests, and oversaw claims activities.
• Led internal and external operational meetings.
• Supported compliance requests and contractual processes.

Medicaid Consultant at Administración de Seguros de Salud (ASES) (2014-01 – 2015-12)

• Reviewed Medicaid protocols and contractual specifications.
• Coordinated administrative transition processes with carriers and leadership.
• Supported compliance audits and audited pharmacy transactions.
• Prepared documentation and reviewed Medicaid marketing materials.

Medicaid & Medicare Consultant at Valentín-Cameron & Associates (2014-01 – 2014-12)

• Reviewed Medicaid protocols and NCQA Patient-Centered Medical Home standards.
• Provided operational feedback to support NCQA implementation.
• Prepared administrative documentation and participated in client meetings.

Medicare Client Advisor at Catamaran (PBM Services) (2011-01 – 2014-12)

• Managed Medicare Advantage pharmacy operations, eligibility, PDE, and compliance issues.
• Participated in client and internal account management meetings.
• Reviewed CMS reporting, pharmacy claim transactions, and compliance audit requests.

Enrollment & Reconciliation Supervisor at Cooperativa de Seguros de Vida de Puerto Rico (COSVI) (2007-01 – 2009-12)

• Supervised enrollment operations, including eligibility, CMS, and ASES batch files.
• Developed reports and training materials for enrollment updates.
• Reviewed and reconciled PDE, RAPS, and CMS submissions.

Training Coordinator at COSVI (2006-01 – 2007-12)

• Developed Medicare Advantage presentations and training programs.
• Supported executive leadership and compliance with enrollment and marketing materials.

Training Coordinator at MMM Healthcare (2005-01 – 2006-12)

• Conducted customer service training and presentations.
• Coordinated cross-training across departments to improve service quality.

Quality Assurance Analyst at MMM Healthcare (2004-01 – 2005-12)

• Conducted call monitoring and compliance verification for HIPAA and CMS requirements.
• Prepared reports and provided coaching to improve service quality.

Customer Service Supervisor at Humana Puerto Rico (2000-01 – 2004-12)

• Supervised call center operations, monitored performance, and trained staff.
• Maintained service levels and resolved coverage issues and customer complaints.

Customer Service Representative at Humana Puerto Rico (1997-01 – 2000-12)

• Provided customer support, handled benefit inquiries, and resolved customer complaints.

Consultant at Hewitt Associates of Puerto Rico (1995-01 – 1997-12)

Customer Service Representative at Centro Unido de Detallistas (1994-01 – 1995-12)

• Supported customer service, administrative activities, and documentation.

Master's Degree in General Linguistics – University of Puerto Rico (2013-12)

B.A. in High School Spanish Education – University of Puerto Rico (2009-12)