Janette Mora
Chino
Summary
Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking opportunities to expand skills while facilitating company growth.
Overview
22
22
years of professional experience
Work History
Member Services Representative Medicare
Inland Empire Health Plan
Rancho Cucamonga
01.2024 - Current
- Provide Medicare Members with health plan education in regard to and Medi-Cal/Medi-Cal benefit coverage, including understanding coordination of benefits and eligibility rules.
- Meet IEHP and Member Services Call Center standard and policy requirements.
- Provide superior service and strive to assist caller on the first point of contact. Demonstrate a high level of patience and respect; avoid distractions to ensure each caller is assisted promptly and appropriately; follow call handle standards and objectives. b. Assist with Member primary care selections and changes; supply eligibility status of Members c. Member education, material request, programs, ordering ID cards and accessing services. d. When necessary present cases to Member Services Management Team and work with other departments to resolve Member inquiries and/or issues. Including but not limited interpreter requests, referrals questions/concerns, accurately while speaking with the caller.
- Coordinate telephonic translation of calls when Members do not speak English or Spanish.
- Efficient problem solving, time management, initiative, and focus skills requiring minimum supervision and guidance.
- High technological aptitude with efficient adaptability to diverse and changing systems and business conditions.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance. Demonstrate a commitment to understand and adhere to the Regulatory requirements as they relate to the business unit.
- Preserve Member’s confidentiality by authenticating callers (submitting guardianship documents for verification, establish guardianship alerts, authentication passwords and confidentiality alerts as needed).
- Demonstrate a commitment to LEAN by participating in process improvement projects Events/Huddles.
- Assist Members with navigating self-service options.
- Maintain knowledge of other departments and the roles they play in Member Services standard work processes, to ensure proper handling and tasking of calls.
- Assist Members with Pharmacy benefit inquires/concerns; coverage determinations.
- Assist Members with authorizations/referrals; organizational determinations.
Member Services Representative Medi-Cal
Inland Empire Health Plan
Rancho Cucamonga
02.2023 - 01.2024
- Provide Members with health plan education in regard to and Medi-Cal benefit coverage, including understanding coordination of benefits and eligibility rules.
- Meet IEHP and Member Services Call Center standard and policy requirements.
- Provide superior service and strive to assist caller on the first point of contact. Demonstrate a high level of patience and respect; avoid distractions to ensure each caller is assisted promptly and appropriately; follow call handle standards and objectives. b. Assist with Member primary care selections and changes; supply eligibility status of Members c. Member education, material request, programs, ordering ID cards and accessing services. d. When necessary present cases to Member Services Management Team and work with other departments to resolve Member inquiries and/or issues. Including but not limited interpreter requests, referrals questions/concerns, accurately while speaking with the caller.
- Coordinate telephonic translation of calls when Members do not speak English or Spanish.
- Efficient problem solving, time management, initiative, and focus skills requiring minimum supervision and guidance.
- High technological aptitude with efficient adaptability to diverse and changing systems and business conditions.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance. Demonstrate a commitment to understand and adhere to the Regulatory requirements as they relate to the business unit.
- Preserve Member’s confidentiality by authenticating callers (submitting guardianship documents for verification, establish guardianship alerts, authentication passwords and confidentiality alerts as needed).
- Demonstrate a commitment to LEAN by participating in process improvement projects Events/Huddles.
- Assist Members with navigating self-service options.
- Maintain knowledge of other departments and the roles they play in Member Services standard work processes, to ensure proper handling and tasking of calls.
Census Field Supervisor
Census Bureau 2020
Ontario
02.2020 - 09.2020
- Supervised a team of 10 employees to enumerate homeless population in the community through outreach programs. Promoting positive work environment through effective communication, active engagement and hands-on assistance. Managed payroll and scheduling.
Health Plan/Advocate Member Representative
Kaiser Foundation Health Plan
Fontana
06.2004 - 01.2012
- Managed member conflicts/grievances and challenging situations in person in short time frames.
- Advocate for patients.
- Liaison between patients and health plan/hospital departments and staff.
- Extensive knowledge in health plan benefits and services.
- Consulted with members regarding needs and addressed concerns.
- Displayed strong telephone and in person customer service skills, effectively handling difficult cases.
- Investigated member issues using knowledge base and personal experience to complete timely resolutions.
- Trained front office staff to assist in member questions and concerns.
- Worked under strict deadlines.
- Maintained high-volume workload within fast-paced environment and consistently met performance benchmarks.
- Collected customer feedback, passing information for review through case work.
- Supervise and mentor new employees.
Education
High School Diploma -
Ganesha High School
Pomona, CA06.2000
Skills
- Effective leadership and management
- Excellent customer service
- Analytical and problem solving
- Knowledge of health care systems and practices
- Excellent verbal and writing skills
- Bilingual
- Problem solver
- Organized
- Responsible
- Flexible
- Team player
Timeline
Member Services Representative Medicare
Inland Empire Health Plan
01.2024 - Current
Member Services Representative Medi-Cal
Inland Empire Health Plan
02.2023 - 01.2024
Census Field Supervisor
Census Bureau 2020
02.2020 - 09.2020
Health Plan/Advocate Member Representative
Kaiser Foundation Health Plan
06.2004 - 01.2012
High School Diploma -
Ganesha High School