Customer Care Associate
Maryland Heights, MO
- Must be bilingual; English & Spanish.
- 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.
- 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 achieve 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 the 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 in-network and out-of-network reimbursement rates and states multiple networks to providers.
- Refers callers requesting provider information to Provider Services regarding professional provider selection criteria and application process.
- Refers patients/EAP clients to the 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.
- 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.
A-Line Staffing Solutions