JANIEN JUNIO

Prior Authorization Management: Served as the primary point of contact for healthcare providers, navigating complex medical necessity criteria to facilitate accurate and timely prior authorization approvals.

Provider Relations & Support: Guided physicians, nurses, and billing staff through the prior authorization inquiry process over the phone, resolving complex eligibility and documentation issues with high accuracy.

SLA & Efficiency Excellence: Maintained a high-volume queue of inbound provider inquiries, consistently meeting strict turnaround time metrics to ensure uninterrupted patient care.

Digital Tools Navigation: Guided healthcare providers step-by-step through the insurance portal and online tools, accelerating portal adoption and reducing repetitive phone inquiries.

Provider Inbound Support: Assisted healthcare providers with comprehensive telephone inquiries regarding member benefits, patient eligibility, and complex claim statuses, ensuring accurate information delivery and resolving potential disputes efficiently.

First-Contact Resolution: Provided effective, comprehensive resolutions to healthcare provider inquiries regarding complex claims and benefits, significantly improving provider satisfaction and reducing repeat inquiry rates.

Self-Service Promotion: Empowered members, providers, brokers, and employers by delivering clear, step-by-step navigation support for online portals, driving first-contact resolution and improving overall digital user satisfaction.

Problem Resolution & Tech Support: Diagnosed and resolved diverse technical mobility issues, including device activation, SIM card provisioning, roaming configurations, and data connectivity across iOS and Android ecosystems.

Performance Metrics: Consistently met or exceeded monthly performance KPIs, including maintaining an average CSAT (Customer Satisfaction) score of 98% and keeping Average Handle Time (AHT) below target benchmarks.

Consultative Upselling: Leveraged strong active listening to identify gaps in customer plans, successfully upselling premium unlimited data tiers, device protection features and bundle product