Jeanette Espinoza

Managing Cases:

· Watching to ensure nothing becomes an aged case in Sharepoint, reassigning and/or working the case yourself, informing the assigned agent and supervisor of next steps.
· Assigning new cases to all members of the team, as well as reassigning cases when an agent may no longer be with the company or is out on RTO or sick.
· Communication with your team regarding expedited cases and trends. Work closely with your supervisor and your assigned QA Analyst on expedited cases to ensure accuracy.

Production:

· Priority is to be placed on working expedited, unassigned and aged cases.
· Beyond the above, the expectation is that each Team Lead will work up to 4 cases daily. If there are extenuating circumstances as to why cases cannot be worked, there must be a well documented reason. Any trend of not working the assigned cases by a Team Lead without such documented reasons will need to be addressed by the reporting supervisor.

Subject Matter Expert (SME):

· Answer agent questions in the Teams Channel/Chat
· Work with your supervisor to ask and follow up on escalated feedback and/or questions.
· Proficient knowledge of resources including OneNote, the Maximus Library and the Agent Workflow.
· Work with Training and QA to develop refresher training and advisement memos based on observed trends.

General Responsibilities:

· Posting daily in Teams regarding the following: IT Issues affecting multiple users Lunch/Break status posts Responding to agent questions Case Tracker update posts/reminders.
· The Team Lead will be expected to assist with monitoring and answering any questions related to cases from your team. Agents should tag the Team Lead to ensure that they are alerted and do not miss the question. If the question has received no response within 30 minutes, the agent can then send a direct message to the Team Lead, no sooner. If the question cannot be answered by the Team Lead, they are expected to research for the answer as well as reach out to their supervisor as well as their assigned QA Analyst.

· Analyzing claim information to determine the cause of outstanding issues.
· Assessing eligibility requirements based on UI Code, Policies, and Procedures.
· Evaluating wage and earnings.
· Communicating with claimants and employers by phone to obtain missing information.
· Working closely with subject matter experts to gain further understanding of unique issues and how to address them.
· Referring more complex issues to supervisor or tenured staff via email.
· Notating all contacts and actions taken on a claim clearly and thoroughly.
· Demonstrating the ability to make timeline and logical decisions.
· Via email requests of employer phone numbers to supervisor.
· All other duties as assigned by management to support claim processing.

· Trained behavioral technician and fill in as a technician when needed and/or provide routine therapy hours on a consistent scheduled basis.
· Opening and/or closing the center based on business needs.
· Responsible for assisting with the day to day scheduling adjustments.
· Coordinating and assisting major and minor scheduling changes as directed.
· Monitoring client and technician cancellations in accordance of our cancellation policies.
· Supports patients and clinicians during center-based services.
· Regular cleaning and sanitizing of entryways, common areas, high-traffic office space and other areas of the center as determined by the Operations Manager.
· Assist with the preparation and maintenance of employee and patient files in accordance with CARD policies and HIPAA standards.
· Act as the greeter for the center and maintain a warm and welcoming environment providing excellent customer service.
· Maintain inventory of all company equipment.
· Attend required trainings and meetings.
· Represent CARD professionally and ethically to internal and external stakeholders.
· Via Emails to directors and staff with goals and accomplishments.
· Via emails sent out to patients showing monthly schedules.
· New client phone calls and communication with existing clients.

· Responsible for increasing membership through direct sales and marketing of Molina Medicare
products to dual eligible, Medicare-Medicaid recipients within approved market areas to achieve
stated revenue, profitability and retention goals, while following ethical sales practices and adhering
to established policies and procedures.
· Develop sales strategies to procure sufficient number of referrals and other self-generated leads to
meet sales targets through active participation in community events and targeted community
outreach to group associations, community centers, senior centers, senior residences and other
potential marketing sites.
· Generate leads from referrals and local-tactical research and prospecting.
· Work assigned (company generated) leads in a timely manner.
· Schedule individual meetings and group presentations from assigned/self generated leads.
· Achieve/Exceed monthly sales targets.
· Conduct presentations with potential customers.

· Customize sales presentations and develop sales
skills to increase effectiveness in establishing rapport, assessing individual needs and
communicating product features and differences.
· Enroll eligible individuals in Molina Medicare products accurately and thoroughly complete and
submit required enrollment documentation, consistent with Medicare requirements and enrollment
guidelines. Assist the prospect in completion of the enrollment application. Forward completed
applications to appropriate administrative contact within 48 hours of sale.
· Ensure Medicare beneficiaries accurately understand the product choices available to them, the
enrollment process (eligibility requirements, Medicare review/approval of their enrollment
application, timing of ID card receipt, etc.) and the service contacts and process.
· Track all marketing and sales activities, as well as update and maintain sales prospects daily, weekly
and monthly results in SalesForce.
· Work closely with network providers to identify and educate potential members; participate in
provider promotional activities.

· Greet and engage customers, uncovering their home furnishing needs and helping them make their
design vision become a reality.
· Provide world class customer service and offer customers an unforgettable shopping experience.
· Build rapport with clients, earning their business through your ability to demonstrate exceptional
product knowledge, strong interpersonal skills, and excellent listening skills.
· Develop and maintain a customer base through networking and client follow up to ensure customer
satisfaction before and after the sale.
· Generating sales through a low pressure consultative approach.

· Management- Daily operations, staffing, set daily and monthly goals. Administration, delegation,
enforcing policy, training, evaluating.
· Accounting- Prepare and examine financial records, revenue audits, weekly key indicators. Monthly P&L’s and projection tools.
· Accounts Payable- Creating, reviewing and paying invoices.
· Sales- Open new accounts, sell the program. Work with customers to help them find what they want.
· Telemarketing- Build a clientele list, work with referrals and word of mouth and social media.
· Collections- Responsible for reaching out to customers to collect payment for overdue bill.
· Customer Service- Helping customers efficiently, in a friendly manner. It's essential to be able to
handle issues for customers and do our best to ensure they are satisfied.
· Applications- Evaluate, authorize and verify applications.
· Loans- Advise borrowers on financial status and methods of payments.
· Cash Handling- Taking Cash, credit card and over the phone payments. Making bank deposits at the
end of shift.
· Computer Skills- Proficient with MS Word, excel, and power point.
· Accolades- Benefits Plus contest winner 2018.