Jodana Joseph
Tomball,TX
Summary
Results driven professional, skilled in training,
coaching, mentoring, problem solving,
Dedicated to delivering the highest quality
customer service, administrative assistance via responsiveness, reliability, assurance, empathy and professionalism.
Overview
19
19
years of professional experience
Work History
Claim Initiator
John Hancock
01.2024 - 01.2025
- Reviewed and assessed Long-Term Care claims to determine eligibility and payout amounts based on policy terms.
- Collected and verified necessary documentation (e.g., medical records) to substantiate and validate claims.
- Communicated with policyholders and their authorized representatives (HIPAA-compliant or Power of Attorney) to request additional information or clarify claim details.
- Scheduled and coordinated virtual and onsite assessments with licensed nurses to evaluate claim eligibility.
- Provided policyholders with clear explanations of policy language and coverage details.
- Managed claims paperwork, ensuring all forms are completed accurately and submitted in a timely manner.
- Addressed policyholder inquiries, offering guidance throughout the claims process, and resolving any issues that arise.
- Tracked and follow up on pending claims, ensuring all required information is received and claims are progressing efficiently through the system.
- Handled complex or escalated claims, resolving disputes over claim decisions or delays.
- Ensured compliance with company policies, industry regulations, and legal requirements throughout the claims process.
- Consistently exceeded monthly productivity and quality metrics, demonstrating strong attention to detail and a commitment to maintaining high standards in claims processing.
Customer Quality Representative
Apotex Corp.
12.2019 - 01.2024
- Communicate with Legal Team concerning legal related issues.
- Communicate with FDA concerning quality product complaints/adverse. reactions & efficacy issues.
- Correspond with Accounting Department for. pharmacy/wholesaler/distributor/customer credit and reimbursement.
- Correspond with wholesaler customers providing donation products.
- Connect pharmacies to Drug Information department for Medical. Professional advice.
- Create FedEx/UPS Label and Call Tags.
- Perform daily reviews of cases to ensure no deviation.
- Review comments on Amazon & Facebook.
- Review and create expired license reports.
- Communicate with Drug Safety for adverse related issues.
- Create reports for company financial department.
- Review daily emails and respond accordingly.
- Distribute emails to team.
- Implement cost-saving initiatives that addressed long-standing problems.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Led projects and analyzed data to identify opportunities for improvement.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
- Learned new skills and applied to daily tasks to improve efficiency and productivity
- Worked with customers to understand needs and provide excellent service.
Compliance Clerk
Memorial Healthcare System
11.2016 - 11.2019
- Processing and distributing compliance.
- Adheres to relevant laws and procedures.
- Scan documents to appropriate database.
- Note medical paper mail with correct medical codes.
- Review claim and authorization denial.
- Communicate with management via email.
- Mail out documents.
- Maintained facility-related materials and supplies.
- Entered into record-keeping systems appropriate data needed to create new records or update existing ones.
- Collected detailed notes on investigations and other communication to adhere to legal requirements and enhance recordkeeping.
- Investigated incidents and accidents to identify causes and potential preventive measures.
- Advised clients on compliance fraud and investigations, as well as potential remedies and required actions.
- Completed field checks to verify licenses and permits for various business.
Member Service Coordinator
Memorial Hospital/SFCCN
03.2014 - 07.2016
- Responsible for communicating with Physicians, insurers, patients, and dependents via telephone for several line of business.
- Effective liaison between members, staff, physician offices and various HMO's and Medical plans.
- Emphasizes member education, customer service and front-line problem solving.
- Resolving member and/or provider billing issues.
- Perform insurance verification.
- Review prior authorization.
- Managed over 50 customer calls per day.
- Cross-trained and provided backup support for organizational leadership.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Lead New Rx/Customer Service Representative
Caremark Mail Order Pharmacy
04.2006 - 03.2012
- Take on team escalating calls.
- Delegating tasks of team members.
- Motivating team to effectively achieve goals.
- Process new mail order prescriptions request via phone from physicians and patients.
- Effectively diffuse and resolve member issues regarding prescription request.
- Educate patients on benefits of mail order prescription process.
- Research and investigate delays on orders and provide timely feedback to patients and doctors.
- Contact pharmacy for prescription transfers.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Updated account information to maintain customer records.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Increased efficiency and performance by monitoring team member productivity and providing feedback.
- Implemented and developed customer service training processes.
- Handle 60 or more calls per day.
Education
High School Diploma -
North Miami Senior High School
07.1999
Skills
- Microsoft Word, Excel, Access, PowerPoint, Outlook Express, Microsoft Windows, XP and Microsoft Office XP, Presentations, Spreadsheet, Email communication, Microsoft Edge, HTML, JavaScript, IOS/Swift, WordPress
- Ability to handle busy workload, work Independently and under pressure
- Able to tackle variety of challenging work
- Excellent communication and team building skills
- Leadership experience
- Collaboration talent
- Problem -solving abilities
REFERENCE
Available upon request
Contact
Texas , FL 77375
Education
Miami, FL
Languages
English
Full Professional
French
Full Professional
Timeline
Claim Initiator
John Hancock
01.2024 - 01.2025
Customer Quality Representative
Apotex Corp.
12.2019 - 01.2024
Compliance Clerk
Memorial Healthcare System
11.2016 - 11.2019
Member Service Coordinator
Memorial Hospital/SFCCN
03.2014 - 07.2016
Lead New Rx/Customer Service Representative
Caremark Mail Order Pharmacy
04.2006 - 03.2012
High School Diploma -
North Miami Senior High School
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