Customer Service Representative - Managed Care
*** This is a Full-Time, Benefits Available, CONTRACT position expected to last 6 months or longer! ***
Customer Service Representative Job Summary:
**MUST reside in NY, RI, or FL**
Customer Service Representative Background:
- Addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
- Verify member eligibility, claim and authorization status for providers.
- Responsible for thorough follow-up and completion of all member, and provider inquires or requests
- Responsible for accurate, complete and correct documentation into Facets regarding all issues, and/or inquires, complaints and grievances
- Function efficiently and productively in a high-volume telephone call center.
- Maintain departmental productivity and quality standards.
- Provide follow-up assistance as needed
- Route escalated calls to the appropriate Member Liaison, Supervisor or Call Center Manager
- Refer issues to health networks and/or make recommendations for further contacts
- If designated, responsible for processing all member transportation request within 1 business day of receipt and coordinating all aspects of the process with clinic, provider and member as appropriate or necessary
- Requires an education level of at least a high school diploma or GED.
- Around 1 year customer service experience with at least 6 months experience in an office setting, call center setting, or phone support role.
- Healthcare experience is required, including basic familiarity with medical terminology.
- Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
- Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
- Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
- Must test at a minimum of 30-40 wpm typing with a high level of accuracy.