TIJUANA ENOCH

Adjust property and casualty claims if needed. Not a full time position.

• Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities
• Performed needs analysis to obtain information required to make appropriate health insurance product recommendations
• Developed sales leads from direct referrals, networking and targeted marketing campaigns
• Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations
• Conducted annual reviews of existing policies to update information and upsold ancillary products.
• Calculated premiums and established payment methods for sales
• Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas

• Prepared, calibrated and monitored production to maintain optimal KPI levels and consistently achieve daily targets
• Evaluated employees' strengths and assigned tasks based upon experience and groomed subject matter experts
• Provided coaching and counseling to between 60-100 employees weekly to encourage professional growth as well as meet short- and long-term goals
• Identified individual employee's unique work styles and adapted management methods harmonizing teams
• Handled customer complaints, resolved issues and adjusted policies to meet changing needs
• Utilized standard operating procedures, effective crew resource management, communication and procedures specified in company operation manual
• Introduced team contests and goals to enhance productivity and improve employee morale
• Trained and mentored classes of sometimes over 50 new and returning agents hired to fulfill various roles.
• Verified proper tracking in newly created databases of all students and instructors leaves, attendance, adjusted payroll hours, scores and overall performance
• Monitored day-to-day activities of teams numbered between 5 to over 30 employees, noting gaps between learning, implementation and execution needing improvement while implementing plans for recertification.
• Trained new and returning Agents on Humana product knowledge and systems which included Market Point University platform, procedures and all CMS AHIP compliance requirements.
• Facilitated/ Proctored training required for testing certifications necessary for Licensed Agent role fulfillment in person and virtually for Humana and CMS AHIP.

• Responded to customer requests for products, services and company information
• Assisted customers with setting appointments, shipping and special order requests, and arranging merchandise pick-up at other locations for prescriptions via Humana Pharmacy
• Liaison between members, pharmacies, healthcare providers and necessary agencies to resolve discrepancies and create effective solutions to access to care situations using a one call resolution methodology.
• Used company troubleshooting resolution tree to evaluate technical problems in system platforms preventing efficient call flow.
• Expertise to find appropriate solutions assisting other Customer Service and Licensed Sales Agents.
• Cultivated customer loyalty, promoted repeat customers and improved sales through the Humana perfect call experience model
• Recommended Medicare Advantage Plans and OSB's to customers, thoroughly explaining details, conducted needs analysis and completed applications for future coverage
• Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions
• Helped members complete purchases, locate items and join reward programs to promote loyalty, satisfaction and member retention using call flow checklist, Altitude,
• Coached employees and trained on methods for handling various aspects of sales, complicated issues and difficult customers using Market Point University.
• Researched issues to obtain appropriate answers to customer inquiries using Mentor/Howie, Humana.com
• Educated staff on strategies for handling difficult customers and challenging situations utilizing soft skills
• Met and exceeded upsell goals by highlighting target plans with strategic promotional approaches.

• Performed needs analysis to obtain information required to make appropriate Highmark Blue Cross health insurance product recommendations utilizing Healthcare.gov(First Highmark Blue Cross then Humana)
• Reported policy changes and company conditions affecting customer satisfaction in a compliant manner
• Verified insurance coverage via telephone and online interactions to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities for Humana
• Displayed consistent, positive attitude towards customers, peers and other personnel, even during high-stress situations
• Upsold additional products and services after identifying customer needs and requirements
• Used soft skills to de-escalate frustrated customer inquiries with positive survey feedback for Humana

• Reviewed submitted documents to check compliance and enforce recordkeeping policies
• Responded to customer needs through competent customer service and prompt problem-solving
• Coordinated logistics with international ships, intermodal trucking partners and U.S. Customs for accurate processing of products using Maritime Hazmat product handling training to load on international ships.
• Worked with corrective action teams to assess historical solutions and make proactive procedural adjustments.