Summary
Overview
Work History
Education
Skills
Timeline
Generic

Joy Lenox

HOUSTON

Summary

Results driven healthcare professional with 8+ years of experience in insurance & member services, specializing in Medicaid benefits, prior authorizations, & complex case resolution. Proven ability to manage high-volume workloads while maintaining exceptional quality. Compliance & customer satisfaction. Skilled in supporting appeals & grievances, resolving escalated issues, & ensuring adherence to HIPPA regulatory standards.

Overview

9
9
years of professional experience

Work History

Provider/Member Service Representative

Molina Healthcare
Houston, Tx (Remote)
11.2025 - Current
  • Guide members through prior authorizations process for procedures & prescriptions.
  • Support Appeals & Grievance's-related case, ensuring accurate documents & resolutions.
  • Maintain accurate member records in compliance with regulatory standards.
  • Research & resolve complex issues involving denied claims, coverage limitations & benefits.
  • Coordinate provider credentialing processes to ensure compliance with regulations and standards.
  • Ensure strict adherence to HIPPA & healthcare guidelines.
  • Manage a large database of provider information, consistently updating contact details & other relevant records.
  • Consistently achieve high performance metrics including quality scores & customer satisfaction.

Benefits Customer Service Representative

Manhattan Life Insurance
Houston, TX
03.2023 - 10.2025
  • Assisted members with benefits inquiries, ensuring accurate & timely responses.
  • Educated members on policy details & coverage options to enhance understanding.
  • Processed claims efficiently, maintaining compliance with company standards & regulations.
  • Investigated & resolved escalated member concerns with accuracy & efficiency.
  • Maintained detailed compliant documentation with CRM systems.

Connections Care Specialist

Globe Life & Accident Insurance Company
Houston, TX (Remote)
06.2017 - 03.2023
  • Delivered personalized care & support to policy holders, addressing individual needs & concerns.
  • Provided end-to-end customer support including billing, policy updates, & general policy inquires.
  • Achieved strong first-call resolution & consistently met performance benchmarks.
  • Assisted members in identifying ryder plans tailored to members coverage goals & needs.
  • Conducted comprehensive policy reviews to ensure adequate coverage & compliance with regulations.
  • Educated members on product features, benefits, & claims process for informed decision-making.

Education

High School Diploma -

Florin High School
Sacramento, CA
06-1998

Skills

  • Medicaid eligibility/ policies & procedures
  • Appeals & grievances processing
  • Prior authorizations
  • Claims & reviews
  • Healthcare compliance (HIPPA regulations)
  • Benefits administration
  • Compliance reporting
  • Managed care experience
  • Problem solving aptitude
  • Customer service
  • Escalation handling
  • Complaint handling

Timeline

Provider/Member Service Representative

Molina Healthcare
11.2025 - Current

Benefits Customer Service Representative

Manhattan Life Insurance
03.2023 - 10.2025

Connections Care Specialist

Globe Life & Accident Insurance Company
06.2017 - 03.2023

High School Diploma -

Florin High School
Joy Lenox