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Customer Care Associate - BILINGUAL
Ref No.: 18-19952
Location: Maryland Heights, Missouri
Job Title:        Customer Care Associate – BILINGUAL
Location:        Maryland Heights, MO 63043
Duration:        3 Months (Temp to Hire)
 
Description:
This position is a frontline service position providing assistance to Client's members and providers regarding programs, policies, and procedures.

Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems.

 
Essential Functions:
  • Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
  • Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
  • Resolves customer administrative concerns as the first line of contact this may include claim resolutions and other expressions of dissatisfaction.
  • Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
  • Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
  • Educates providers on how to submit claims and when/where to submit a treatment plan.
  • Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
  • Informs providers and members on Client's appeal process.
  • Links or makes routine referrals and triage decisions not requiring clinical judgment.
  • Provides information regarding Client's in-network and out-of-network reimbursement rates and states multiple networks to providers.
  • Refers callers requesting provider information to Provider Services regarding Client's professional provider selection criteria and application process.
  • Refers patients/EAP clients to the Client's Care Management team for a provider, EAP affiliate, or Facility.
  • Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers
Requirements/Certifications:
  • Shift will be within 8 AM 8 PM range candidates must have open availability
  • Bilingual resources required
  • Prefer candidates who do not come from a call center background, and come from other customer service roles (retail, restaurants, etc.)
  • Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
  • Must agree to observing service for the purpose of training and quality control.