Call Center Rep - SUMMARY:
Provide excellent service in response to requests or questions from providers of service; anticipating and proactively informing and educating them on the benefit plan, pre-authorization requirements, and network status requirements while sharing any other information relevant to the subject at hand.
Call Center - ACCOUNTABILITIES:
90% -- Inbound Customer Inquiries:
• Receive/respond to member telephone inquiries about their benefits/eligibility; explaining how to receive maximum benefit reimbursement.
• Anticipate and proactively inform and educate members regarding their benefit plans, preauthorization requirements; verifying network status and steering to high value providers while sharing any other information relevant to each call or situation that could negatively affect the member experience and/or their out of pocket costs.
• Own and research calls to completion and resolution, ensuring member satisfaction.
• Inform members about and facilitate the referral and preauthorization process.
• Review and determine which policy provisions, guidelines, medical review requirements, and/or procedures of other Trust departments apply to the member’s need or concern.
• Perform special projects and assignments including, but not limited to, testing online system changes and enhancements; as well as suggesting system improvements.
REQUIRED EXPERIENCE AND KNOWLEDGE: REQUIRED EXPERIENCE AND KNOWLEDGE:
• 2 + years of experience working in the health care industry, including three years of experience working in a call or customer care center that required interaction with customers in situations where the customer was not always satisfied.
• Knowledge of insurance and medical terminology.
PREFERRED EXPERIENCE AND KNOWLEDGE:
• Experience working in eligibility, enrollment, or billing with knowledge of eligibility and enrollment and administrative practices and procedures.
• Experience communicating benefit determinations and to subscribers and providers.
• Knowledge of medical terminology and diagnostic/procedure codes.
• Experience utilizing Microsoft Word, Excel, and Outlook; HealthRules; Data Dimensions, and other