Customer Care Associate

Job Description

Title: Customer Care Associate Bilingual

Duration: 3 months (Temp to Hire)

Location: Maryland Heights MO

Responsibilities:

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:

·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 its 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 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 providers needs are completely met.

·Provides information regarding in network and outofnetwork 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 customer’s comments/information and forwards required information to the appropriate staff.

Requirements/Certifications:

·5 Openings: bilingual only (Spanish)

·Right to hire

·Extra "alternate" offers will be made; starts will be "first come, first served" based upon clearance

·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.

If you are not interested in looking at new opportunities at this time I fully understand. I would in that case be appreciative of any referrals you could provide from your network of friends and colleagues in the industry. We do offer a referral bonus that I’d be happy to extend to you if they turn out to be a great fit for my client.

Thank you for your time and for consideration. I look forward to hearing from you.

Qualifications

Additional Information

Kind Regards

Sumit Agarwal

732-902-2125