Jessica Jones

*Provide elite level, proactive support with end to end resolution for members via inbound communication.

*Graciously advocate for members’ needs by facilitating provider contacts for appointment scheduling and ensuring claim accuracy.

*Resolve complex claims and calls that have been escalated from front line advocates.

*Collaborate with partners such as medical, clinical, behavioral and RX to resolve issues as needed.

*Connect members to appropriate programs and recourses as needed.

*Quote In Network and Out of Network benefits, educate on deductible and out of pocket and estimate care costs.

*Effectively and accurately utilize company standard operating procedures.

*Excel at meeting numerous department metrics.

*Educate clients on the basics of property tax analysis.

*Handle inbound/outbound customer-related phone inquiries.

*Use multi-tasking skills to assist, research, and resolve customer issues,

*Efficiently engage clients during high volume sales season through education and value-add

*Collaborated with nurses and social workers in inpatient institutions to plan for client’s discharge

*Created weekly client contact schedules for rehab specialists and program manager

*Assessed client behaviors and symptoms to determine treatment recommendations as least restrictive

*Trained rehab specialists

*Provided intense case management to individuals with mental illness in clinic or in community

*Researched appropriate and effective resources for clients based on client needs

*Worked on-call weekly and at least one weekend per month for clients in mental health crisis

*Documented sessions with clients according to Texas state code via organization’s software systems

*Knowledgeable in Medicaid and Medicare policies and practice