Jenmila McKenzie

• Answering Inquiries: Respond to member calls, providing clear and accurate information about their health insurance policies.
• Resolving Issues: Troubleshoot and resolve member concerns, such as claims, billing, or coverage issues.
• Providing Policy Information: Explain policy details, including benefits, deductibles, copays, and coverage limits.
• Educating Members: Inform members about available resources, such as wellness programs, disease management services, or patient advocacy.
• Updating Member Information: Verify and update member demographics, contact information, or other relevant details.
• Documenting Interactions: Accurately log member interactions, including issues resolved, information provided, or follow-up actions required.
• Escalating Complex Issues: Identify and escalate complex issues to specialized teams, such as claims adjusters or clinical experts.
• Promoting Health Insurance Products: Provide information about additional health insurance products or services, such as dental, vision, or supplemental coverage.
• Coordinating with Providers: Reach out to healthcare providers' offices to:

- Schedule appointments for members

- Sort out claims inquiries and resolve issues

- Provide member information and verify eligibility

- Facilitate communication between members and providers

• Developing and implementing quality control procedures and policies
• Conducting regular audits and inspections to identify any deviations from quality standards
• Analyzing data and performance metrics to identify areas for improvement
• Collaborating with cross-functional teams to address quality issues and implement corrective actions
• Coaching employees on quality control processes and procedures
• Monitoring and evaluating customer feedback and complaints to identify trends and areas for improvement
• Conducting root cause analysis to determine the underlying causes of quality issues
• Developing and maintaining quality documentation, including standard operating procedures and work instructions
• Participating in the design and implementation of quality improvement initiatives
• Keeping up-to-date with industry best practices and technological advancements in quality control
• Ensuring that the company’s products or services meet customer expectations, and comply with regulatory requirements.

• Responding promptly to customer inquiries via phone, and ensuring a positive customer experience
• Understanding and identifying customer relationships needs and requirements to offer suitable products or services
• Creating and maintaining the effective relationships with customers while recommending products and services based on the conversation with customers based on needs and interests
• Consistently achieving overall performance goals by effectively promoting and selling products and service value of those products and services.