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Customer Care Associate (661028)
Ref No.: 18-12191
Location: Orlando, Florida
Start Date / End Date: 10/15/2018 to 04/14/2019
Job Title: Customer Care Associate (661028)
Location: Orlando FL 32812
Duration: 6 Months


Job Summary:
  • 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.
  • Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call.
  • Performance expectations are to meet or exceed operations production and quality standards.

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.
  • Assist in the mentoring and training of new staff.
  • Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
  • Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
  • Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help Client achieve its business and operational goals.
  • 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.
  • Lead or participate in activities as requested that help improve Care Center performance, excellence and culture.
  • Links or makes routine referrals and triage decisions not requiring clinical judgment.
  • Performs necessary follow-up tasks to ensure member or provider's needs are completely met.
  • 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.
  • Support team members and participate in team activities to help build a high-performance team.
  • Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.

Requirements/Certifications:
  • HS Diploma/GED - Required
  • Pharmacy Technician License (in state of FL) – Strongly Preferred