Jennifer Morales
Mesa,AZ
Summary
Expert in auditing, data analysis, and resolving escalated service issues. Proven track record in enhancing customer satisfaction and mentoring team members for service excellence. Focuses on delivering high-quality results and producing exceptional work.
Overview
24
24
years of professional experience
Work History
Auditor Grievance and Appeals
Health Net Inc.
Woodland Hills, CA
02.2015 - 12.2023
- Conducted internal audits of production processes to identify areas of improvement in product quality.
- Performed data analysis on production results to identify trends and opportunities for process optimization.
- Provided guidance on best practices in quality assurance techniques to other departments within the organization.
- Created detailed documentation of audit findings, including recommendations for resolution of any issues identified.
- Evaluated existing processes for effectiveness and efficiency, recommending improvements as necessary.
Appeals and Grievances Coordinator
Health Net Inc.
Woodland Hills, CA
10.2010 - 02.2015
- Analyzed complex cases to determine appropriate resolution in accordance with relevant laws, regulations and organizational policies.
- Prepared written responses to customers regarding the status of their appeal or grievance filings.
- Coordinated review by internal teams of submitted appeals or grievances.
- Researched case files to ensure accuracy of information prior to making decisions on appeals or grievances.
Account Service Coordinator
Health Net Inc.
Woodland Hills, CA
04.2006 - 10.2010
- Exceeded established service goals while leveraging customer service, sales and employee management best practices.
- Responded to and resolved escalated service issues presented by employer groups, brokers, third-party administrators, and internal sales staff.
- Provided benefit information to enrollment and account installation staff and assisted Sales with open enrollments and Health Fairs.
- Investigated and analyzed complex client-specific problems related to claims, networks, providers, and eligibility, and initiated action with appropriate departments.
- Mentored new hires.
Call Center Quality Analyst
Health Net Inc.
Woodland Hills, CA
06.2004 - 04.2006
- Analyzed customer service calls to identify areas of improvement and provide feedback to agents.
- Maintained detailed records of call center performance and provided reports to management.
- Evaluated customer interactions for compliance with company standards and regulations.
- Provided coaching and guidance to call center representatives as needed.
Member Service Representative
Health Net Inc.
Woodland Hills, CA
08.1999 - 06.2004
- Assisted customers with inquiries about health insurance policies and coverage options in a high-volume call center environment.
- Resolved customer complaints or escalated them as necessary in a timely manner.
- Provided customer service support to answer inquiries about health plans and benefits.
- Investigated denied or underpaid claims and coordinated appeals process as needed.
Education
High School Diploma -
Granada Hills High School
Granada Hills, CA06-1992
Skills
- Root Cause Analysis
- Ability to formulate and write reports and professional correspondence
- Strong organizational, analytical and problem solving skills
- Proven track record in enhancing customer satisfaction and mentoring team members for service excellence
- Experienced With Complex Expedited Issues
Languages
Spanish
Native/ Bilingual
Timeline
Auditor Grievance and Appeals
Health Net Inc.
02.2015 - 12.2023
Appeals and Grievances Coordinator
Health Net Inc.
10.2010 - 02.2015
Account Service Coordinator
Health Net Inc.
04.2006 - 10.2010
Call Center Quality Analyst
Health Net Inc.
06.2004 - 04.2006
Member Service Representative
Health Net Inc.
08.1999 - 06.2004
High School Diploma -
Granada Hills High School