Responsible for communication between all customers via telephone.
Customers include employees, members, physicians, referral sources, and providers.
The communication includes, benefit coverage, medical services, appeals and grievances,
provider access and availability, claims investigation.
The position utilizes computer terminal to manage and obtain essential information.
Researches inquiries and demonstrates a strong ability to resolve issues according to the
Plan document and policies and procedures.
Refers unsolved inquiries and corrections to the appropriate analyst for resolution.
Achieves maximum time effectiveness and customer service by answering all incoming
phone calls within 3 rings.
Provides clerical and telephone support for Case Management program.
Maintains provider file compliance according to directive.
Performs duties as assigned by Supervisor within the scope of knowledge and skill.
Scheduled Days / Hours: m-f 8:30a-5p
High School Diploma or Equivalent required.
Previous customer service experience.
Medical or health insurance background preferred.