Magellan HRSC, Inc.
Customer Care Associate I-1 (Healthcare)
Essential Functions:
- Understands the end to end authorization process, the SBU?s business and business drivers for success.
- Actively listens and probes callers in a professional and timely manner to process authorizations and/or other customer service requests working towards first call resolution.
- Researches and communicates information regarding member eligibility, provider status and authorization inquiries to callers while maintaining confidentiality.
- Resolves customer complaints or concerns as the first line of contact.
- Makes problem resolution and triage decisions not requiring clinical judgment.
- Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
- Transfers calls to clinicians and physicians only for clinically escalated situations.
- Communicates appeal and denial language to providers and members when appropriate.
- Processes withdrawals and other case status changes as needed.
- Understands client and regulatory expectations for accounts in their designated region.
- Recognizes and develops relationships with provider groups through repeat calls, and recognizes provider sensitivities for different health plans.
- Is responsible for reading and retaining information disseminated through multiple resources, ensuring calls are handled accurately and appropriately per current account information.
- Processes fax attachments in between calls.
- Responsible for meeting SBU?s Service standards in all categories on a monthly basis, team player, maintain member and provider Confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.
- Participates in SBU?s Service Operations 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 SBU?s Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.
- Assist SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
- Assume responsibility for self-development and career progression.
- Other duties as assigned.
General Job Information
Title
Customer Care Associate I-1Grade
16Job Family
Call_Contact Center_CSCountry
United States of AmericaFLSA Status
United States of America (Non-Exempt)Recruiting Start Date
5/22/2018Date Requisition Created
5/22/2018Minimum Qualifications
Education
GED (Required), High School (Required)License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
Responsibilities
Customer Service experience in a Health Care environment., -Must be a proficient typist (at least 30 WPM) with the ability to maneuver through various computer platforms/screens while verifying a variety of information simultaneously. -Ability to multi-task while staying organized.Competencies
Language(s)
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled