Lorena Najera

Anthem / Elevance Health | September 2012 – Present

• Serve as a subject matter expert supporting brokers, agents, and internal business partners for Medicare Advantage, Medicare Supplement, Part D, and DSNP products.
• Analyze and resolve complex enrollment, commission, claims, authorization, and operational issues impacting brokers and members.
• Collaborate with cross-functional teams to investigate business challenges, identify root causes, and implement effective solutions.
• Train, mentor, and onboard new associates on systems, workflows, compliance requirements, and operational procedures.
• Conduct call audits and provide performance feedback to improve service quality, productivity, and operational effectiveness.
• Research claims payments, denials, and adjustments to ensure accurate resolution and compliance with business standards.
• Support high-volume business operations through phone, chat, and written communications while maintaining quality and productivity goals.
• Identify recurring operational issues and recommend process improvements that enhance efficiency and customer experience.
• Assist agents with certification, licensing, appointment, and compliance requirements.
• Utilize Salesforce, Genesys Cloud, Pulse, BPM, Medisys, and enterprise systems to support business operations and service delivery.

• Performed medical underwriting reviews and enrollment analysis for health insurance applications.
• Evaluated eligibility and enrollment data to ensure compliance with business requirements and regulatory standards.
• Resolved enrollment discrepancies, billing issues, premium reconciliations, and system-related processing errors to ensure accurate member records.
• Maintained membership records and ensured data integrity across multiple systems.
• Analyzed member and enrollment data to facilitate accurate processing and informed operational decisions.
• Analyzed member and enrollment data to support accurate processing and operational decision-making.
• User Acceptance Testing (UAT) and certification testing for system enhancements and operational changes.
• Beacon and Compass implementation support and business readiness activities.
• Development of operational desktop procedures, workflow documentation, and training guides.
• Subject Matter Expert (SME) for Medicare broker support operations and enrollment processes.
• Collaborated with business, operations, compliance, and technology teams to streamline processes and enhance service delivery.