Title: Customer Care Associate
Duration: Till December , possibility of extension
Location: Maryland Heights MO 63043
*Spanish plus*
Description:
This position is a frontline service position providing assistance to 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:
路Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
路Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
路Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
路Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
路Assist in the mentoring and training of new staff.
路Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
路Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
路Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help company achieve its business and operational goals.
路Educates providers on how to submit claims and when/where to submit a treatment plan.
路Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
路Informs providers and members on appeal process.
路Lead or participate in activities as requested that help improve Care Center performance, excellence and culture.
路Links or makes routine referrals and triage decisions not requiring clinical judgment.
路Performs necessary follow-up tasks to ensure member or provider?s needs are completely met.
路Provides information regarding client's in-network and out-of-network reimbursement rates and states multiple networks to providers.
路Refers callers requesting provider information to Provider Services regarding clients鈥檚 professional provider selection criteria and application process.
路Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
路Support team members and participate in team activities to help build a high-performance team.
路Thoroughly documents customers? comments/information and forwards required information to the appropriate staff.
Integrated Resources INC
https://careers.smartrecruiters.com/IntegratedResourcesINC