Janice Cole
Yalaha
Summary
Dynamic Member Advocate with extensive experience at Physicians United Plan, excelling in claims resolution and Medicaid enrollment. Proven ability to enhance customer satisfaction through effective relationship management and education on benefits. Skilled in navigating complex issues while maintaining strong community ties, ensuring members receive optimal support and resources.
Overview
14
14
years of professional experience
Work History
Member Advocate/Benefits Consultant
Physicians United Plan
11.2011 - 09.2013
- Assist members to resolve any issues, claims, provider grievance, and appeals
- Educate members as to plan benefits and copays
- Complete daily logs and document member contact
- Assist Provider Relations Rep with office visits, site reviews, new provider in services
- Assist with referral and authorization issues
Sales Agent Life, Health Variable Annuity
Humana Market Point
08.2005 - 06.2009
- Medicare member sales in to insurance plan based on needs analysis in individual or seminar setting
- Plan and set appointments from referrals, and leads
- Plan and conduct community seminars
- Assist provider's office with billing, coding, authorization, and referral issues
- Complete and submit applications
- Complete and submit daily and monthly reports
Marketing Rep/Facilitated Enroller
United Health Care
11.1999 - 05.2004
- Market and enroll potential members in to one of the following programs based on Economic eligibility: Medicaid Managed care, Family Health Program, Child Health Plus
- Calculate income based on legal financial responsibility using state formulary
- Submit copies of applications to appropriate office or state agency in approved time frame
- Educate members to plan benefits for specific program which they are qualify
- Maintain good relationships with community agencies, area employers, civic groups, schools to increase awareness of program availability
- Complete daily reports
Education
Facilitated Enroller TrainingLicense - Medicaid Managed Care, Child Health Plus, Family Health Plus Program
NY State
03-2025
620 - Insurance License
FL Insurance School
FL03-2025
Licensed Practical Nurse -
Life, Health, Variable Annuity 2-15 License -
Customer Service 4-40 License -
FL Insurance School
FLSkills
- Customer service and support
- Medicaid enrollment and benefits administration
- Claims processing and issue resolution
- Relationship management
Timeline
Member Advocate/Benefits Consultant
Physicians United Plan
11.2011 - 09.2013
Sales Agent Life, Health Variable Annuity
Humana Market Point
08.2005 - 06.2009
Marketing Rep/Facilitated Enroller
United Health Care
11.1999 - 05.2004
Facilitated Enroller TrainingLicense - Medicaid Managed Care, Child Health Plus, Family Health Plus Program
NY State
620 - Insurance License
FL Insurance School
Licensed Practical Nurse -
Life, Health, Variable Annuity 2-15 License -
Customer Service 4-40 License -
FL Insurance School
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