Summary
Overview
Work History
Education
Skills
Websites
References
Timeline
Generic
Jessica Poole

Jessica Poole

Millcreek

Summary

Healthcare professional with 18 years in customer service and 16 years in managed care at Molina Healthcare. Experience includes provider relations, appeals & grievances (demonstrating expertise in research, analysis, and regulatory compliance), and team leadership. Proven ability to resolve complex issues, build strong relationships, improve processes, and drive positive outcomes.

Overview

15
15
years of professional experience

Work History

CUSTOMER CARE REPRESENTATIVE

Amazon Pharmacy
02.2025 - Current
  • Virtually assist customers and other advisors over the phone, email, and on the web with billing/insurance verification, product, or service questions.
  • Manage both inbound and outbound calls.
  • Proactively identify solutions to questions you anticipate our customers having in each interaction.
  • Take a hands-on approach to resolving every issue, owning it from start to finish or partnering with pharmacist and pharmacy staff if clinical advisement is necessary.
  • Provide best-in-class service experience for our customers while working in a fast-paced environment.
  • Help answer customer inquiries regarding their insurance and copays, as well as shipping needs.
  • Provide our customers with technical support when navigating pharmacy.amazon.com.
  • Serve customers in a timely manner to ensure we are maximizing our relationship with them.
  • Understanding each interaction is more than solving a single problem, but an opportunity to build a long-term relationship.
  • Promote customer privacy and safety by maintaining adherence to the company's Work from Home policy.

MANAGER OF PROVIDER SERVICES

Molina Healthcare of Utah
09.2018 - 02.2024
  • Led and managed a team of Provider Services Representatives for both Utah and Idaho, providing guidance, performance feedback, and professional development.
  • Resolved complex provider issues related to contracts, payments, and claims, ensuring compliance with managed care agreements.
  • Developed and implemented network management standards and processes, collaborating with cross-functional teams to improve efficiency and effectiveness.
  • Monitored provider performance, identified areas for improvement, and implemented corrective action plans.
  • Facilitated strategic planning and ensured alignment with organizational goals and regulatory requirements.
  • Consistently exceeded key performance indicators (KPIs) within the Provider Services department.
  • Provided exceptional customer service to providers, addressing their concerns promptly and effectively.
  • Provided support for customers by addressing complaints quickly and efficiently, displaying exceptional customer service skills.
  • Orienting and training employees, encouraging confidence, and helping individuals adapt faster to job roles.
  • Assigned, prioritized, and delegated tasks and responsibilities to departmental employees.
  • Conducted regular staff meetings, provided performance feedback, and fostered a positive, productive work environment.
  • Developed and maintained positive relationships with customers through active listening, clear communication, and empathy.
  • Participate in departmental and interdepartmental meetings as appropriate and necessary.

SR. PROVIDER SERVICE REPRESENTATIVE

Molina Healthcare of Utah
04.2018 - 09.2018
  • Served as a primary point of contact for high-priority providers, educating them on Molina Healthcare policies and procedures.
  • Resolved complex provider issues that required in-depth knowledge of provider services and contracting.
  • Provided subject matter expertise to other departments within the organization.
  • I trained and mentored other Provider Service Representatives.
  • Built and maintained strong relationships with key providers, fostering collaboration and partnership.
  • Utilized active listening techniques to accurately assess customer needs and provide effective resolutions.
  • Performed administrative duties such as filing documents, entering data into the system, and answering phones.
  • Demonstrated proficiency in using various software applications related to customer service operations.
  • Proactively identified and addressed potential customer issues to prevent escalation.
  • Collaborated with colleagues across departments to provide comprehensive solutions for customers.
  • Exceeded customer expectations through personalized, proactive service.
  • Developed and maintained positive relationships with customers through active listening, clear communication, and empathy.
  • Participate in departmental and interdepartmental meetings as appropriate and necessary.

SUPERVISOR, OPERATIONS SUPPORT

Molina Healthcare of Utah
09.2015 - 04.2018
  • Supervises operations support for the Community Connector team within Molina's Healthcare Services function, which may include Care Review, Case Management, and/or Correspondence Processors, as well as Member Location staff.
  • Supervised and mentored a team of Community Connectors, ensuring adherence to quality standards and performance goals.
  • Conducted performance reviews, provided feedback, and identified areas for improvement.
  • Ensured compliance with relevant regulations and internal policies.
  • Developed and delivered training programs to enhance employee skills and knowledge.
  • Collaborated with other departments to improve operational efficiency and enhance member services.
  • Oversees Community Connectors that are assigned to specific clinics, including VBC groups.

SR. PROVIDER SERVICE REPRESENTATIVE

Molina Healthcare of Utah
03.2015 - 09.2015
  • Resolved complex provider issues, including contract disputes, payment discrepancies, and authorization requests.
  • Provided in-depth knowledge of provider services and contracting to internal and external stakeholders.
  • Trained and mentored junior-level Provider Service Representatives.
  • Built strong relationships with key providers and maintained a high level of customer satisfaction.
  • Utilized active listening techniques to accurately assess customer needs and provide effective resolutions.
  • Performed administrative duties such as filing documents, entering data into the system, and answering phones.
  • Provided exceptional customer service to clients, demonstrating strong problem-solving, and communication skills.
  • Resolved customer inquiries and complaints in a timely manner while maintaining a high level of professionalism.
  • Developed and maintained positive relationships with customers through active listening, clear communication, and empathy.
  • Participate in departmental and interdepartmental meetings as appropriate and necessary.

PROVIDER SERVICE REPRESENTATIVE

Molina Healthcare of Utah
01.2013 - 03.2015
  • Educating providers face-to-face and over the phone.
  • Answered provider inquiries regarding claims, eligibility, benefits, and authorizations.
  • Researched and resolved claim payment issues, ensuring accuracy and timely processing.
  • Provided excellent customer service to providers, addressing their concerns promptly and professionally.
  • Utilized active listening techniques to accurately assess customer needs and provide effective resolutions.
  • Exceeded customer expectations through personalized, proactive service.
  • Participate in departmental and interdepartmental meetings as appropriate and necessary.

MEDICARE APPEALS AND GRIEVANCES COORDINATOR

Molina Healthcare of Utah
06.2010 - 12.2012
  • Serves as the point of contact and manages written responses to incoming correspondence, appeals, grievances, and/or complaints from customers and outside agencies.
  • Conducted research and prepared documentation for appeals and grievances.
  • Created and maintained reporting and statistics, checking the HMPS website daily for any incoming Complaint Tracking Modules (CTMs) from the Centers for Medicare & Medicaid Services, and assigning the CTMs to the appropriate department for resolution.
  • Verifying that all CTMs have been resolved correctly, working up a final response back to the Centers for Medicare and Medicaid Services, and staying 100% compliant.
  • Developed and maintained a comprehensive knowledge of the appeals and grievances process, including federal regulations and state laws.

Education

HIGH SCHOOL DIPLOMA -

Valley High School
06.2004

Skills

  • Customer Service (18 years)
  • Managed Care (16 years)
  • Provider Services (9 years)
  • Management (5 years)
  • Supervision (Operations Support) - Oversaw a team of 17 Community Connectors
  • Client Relationship Management
  • Problem-Solving Skills
  • Organizational Skills
  • Performance Management
  • Time Management
  • Complex Problem-Solving
  • Staff Training and Development
  • Process Improvement
  • Conflict Resolution
  • Attention to Detail
  • Task Prioritization
  • Relationship Building
  • Computer Skills - Proficient in Microsoft Office Suite, Salesforce CRM, and QNXT (Healthcare Administration System)

References

References available upon request

Timeline

CUSTOMER CARE REPRESENTATIVE

Amazon Pharmacy
02.2025 - Current

MANAGER OF PROVIDER SERVICES

Molina Healthcare of Utah
09.2018 - 02.2024

SR. PROVIDER SERVICE REPRESENTATIVE

Molina Healthcare of Utah
04.2018 - 09.2018

SUPERVISOR, OPERATIONS SUPPORT

Molina Healthcare of Utah
09.2015 - 04.2018

SR. PROVIDER SERVICE REPRESENTATIVE

Molina Healthcare of Utah
03.2015 - 09.2015

PROVIDER SERVICE REPRESENTATIVE

Molina Healthcare of Utah
01.2013 - 03.2015

MEDICARE APPEALS AND GRIEVANCES COORDINATOR

Molina Healthcare of Utah
06.2010 - 12.2012

HIGH SCHOOL DIPLOMA -

Valley High School

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Jessica Poole