PR:$21/hr-$22/hr

About the Role

• This position is a customer advocate role focused on supporting members and providers by facilitating care and service.
• The role involves providing assistance regarding various aspects of healthcare programs, policies, and procedures.
• The primary responsibility is to handle incoming and outgoing calls related to healthcare benefits, ensuring outstanding service and striving to resolve callers’ needs on the first call.

Responsibilities

• Research and communicate medical information regarding services such as claims, member eligibility, benefits, EAP services, claim status, and authorization inquiries while maintaining confidentiality and protecting health information.
• Meet key performance indicators and service standards, demonstrating compassion to members and providers.
• Identify and respond to crisis calls with appropriate resources.
• Facilitate routine referrals and triage decisions that do not require clinical judgment.
• Assemble and enter patient information into the appropriate delivery system.
• Demonstrate flexibility in job duties and schedule to better serve members and achieve business and operational goals.
• Support team members and participate in activities to build a high-performance team. 
• Assume responsibility for self-development and career progression by participating in ongoing training sessions.
• Stay informed of operational changes to ensure accuracy.
• Identify and report operational problems and inefficiencies to responsible entities.
• Lead or participate in activities to improve Care Center performance, quality, and culture. 
• Navigate systems to document customer comments and information, forwarding required information as necessary.
• Read and retain information from multiple resources to ensure calls are addressed accurately and appropriately.

Education Qualification

• High school diploma or equivalent required. 
• Additional education or certifications in healthcare or customer service are a plus.

Required Skills

• Strong communication skills with the ability to articulate medical information clearly.
• Ability to maintain confidentiality and handle sensitive information.
• Compassionate and customer-focused approach. 
• Flexibility in job duties and schedule.
• Ability to work collaboratively in a team environment.
• Proactive in self-development and career progression.
• Strong problem-solving skills and attention to detail.
• Proficient in navigating and using various systems and resources.