Call Center Rep, Sr

Duties:

To serve as a Member and/or Provider Advocate by possessing knowledge and understanding of the organization's processes, policies and procedures in order to investigate, resolve and/or facilitate resolution of simple to moderately complex issues and/or questions reported by client members, prospective members, healthcare providers, or other entities relating to client Managed Care Organization.
To be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other Member/Provider needs.
To assist and advocate for Members and/or Providers throughout the complaint and appeal process. To assist Members with timely appointment scheduling.

ESSENTIAL DUTIES AND RESPONSIBILITIES
• Verifies member eligibility through THMP and provides support for this activity for the Call Center Representatives, as needed.
• Acts as a secondary resource to Call Center Representatives in the absence of the Team Lead. Responds to escalated calls as appropriate and triages to Management, if necessary.
• Assists with processing workflow queues i.e., urgent requests to ensure timely submittal as requested by the Team Lead.
• Assists with onboarding of new hire employees after training in a Nesting environment. Provides the opportunity for job shadowing and mentorship.
• Completes and manages Pharmacy queue / Right Fax.
• Assists members/providers with billing inquiries and resolves member/provider billing issues.

• Knowledge of managed care, Medicaid, call center desktop support applications, customer relations techniques and
general computer literacy.
• Benefits, claims processing or membership knowledge is preferred.
• The ability to work well with the public and adopt a customer perspective and work well individually and in a team environment
• Effective interpersonal skills and phone etiquette are required
• Strong verbal communication skills
• Good listening skills
• Knowledge of medical terminology
• Problem identification and problem solving skills and able to multitask
• Technical Skills: Typing, 35 WPM
• Bilingual (English-Spanish) preferred

Schedule Notes:
9am-530p-Training will be onsite and once cleared the position in Remote contingent upon performance