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This position is a frontline service position communicating to Client's members and providers Client programs, policies, and procedures. Responsibilities include answering incoming calls on eligibility, benefits, claims, and authorization of services from providers and members. Responsibilities also include the administration of intake documentation in the appropriate systems. Overall, the Customer Service Associate is expected to provide outstanding service to our internal and external customers and strive to resolve member and provider needs on the first call. The CSA provides outstanding service while also achieving operating performance rating of meets or exceeds call center production standards.
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.
Refers patients/EAP clients to the Client's Care Management team for a provider, EAP affiliate, or Facility.
Refers callers requesting provider information to Provider Services regarding Client's professional provider selection criteria and application 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.
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.
Educates providers on how to submit claims and when/where to submit a treatment plan.
Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
Performs necessary follow-up tasks to ensure member or provider's needs are completely met.
Lead or participate in Care Management Center activities as requested that help improve Care Center performance, excellence and culture.
Support team members and participate in team activities to help build a high-performance team.
Demonstrate flexibility in areas such as job duties and schedule in order to aid Care Management Center in better serving its members and help Client achieve its business and operational goals.
Assist CMC efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assume full responsibility for self-development and career progression.
Proactively seek and participate in ongoing training (formal and informal) in all aspects of the Customer Service Associate role.
Assist in the mentoring and training of new CSAs.
Remain responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
Performs various other duties and special projects that are assigned by management on a daily basis while performing primary functions.
Service Delivery Expectations: Must be customer service oriented, meet Client's Service standards in all categories on a monthly basis, be a team player, maintain member and provider confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.
Computer Skills: Must be a proficient typist and able to maneuver through various computer platforms while verifying demographic information on all calls.
Excellent verbal and written communication, organizational and multi-tasking skills.
Must recognize customer service as an ever-changing environment—this causes one to be flexible in scheduling and having the ability to accept change.
Responsible for meeting call handling requirements and daily telephone standards as set forth by the CMC.
Must agree to observing service for the purpose of training and quality control.
Education: College degree.
Experience: Experience in a Customer Service/Health Care environment.
- 2+ years of call center experience in the healthcare industry
- HS diploma/GED Required
- Must be able to work both 8:00 AM - 4:30 PM, 8:30 AM - 5:00 PM
- Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.-Must be able to maneuver through various computer platforms while verifying information on all calls.-Must be able to talk and type simultaneously.
-Must be flexible in scheduling and comfortable with change - customer service is an ever-changing environment.-Responsible for meeting call handling requirements and daily telephone standards as set forth by management.-Must agree to observing service for the purpose of training and quality control.
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