Position: Customer Service Reps and Member Service Reps – CALL CENTER
Location: Pasadena, CA
English, Spanish, Chinese, and Vietnamese speakers needed.
Under general supervision, following established procedures, provide member and customer service by assisting and direct patients and or providers in an empathetic and caring manner, efficiently and timely, and complete appropriate documentation. Respond to provider inquiries and attempt to resolve provider concerns or refer to management for resolution.
Duties and Responsibilities:
- Comply with UM, Claims, Customer Service policy and procedures.
- Answer incoming calls from our customers to include but not limited to: members, providers, health plans, insurance brokers, and hospitals in accordance with HIPAA guidelines.
- Maintain an average handle time of no more than 10 minutes
- Maintain our average wait time to 5 minutes or less.
- Research and resolve authorizations, claims, eligibility inquiries and any additional concerns in a timely fashion.
- Accurate documentation of calls into customer service module using appropriate wrap up codes.
- Retrieve and return voicemail calls from customers and respond before the end of the day in accordance with HIPAA guidelines.
- Member Service/Representative assists Supervisor and Manager with other duties as assigned. As well as supporting other departments when needed.
· Member outreach communications via mail or telephone.
1. High School Graduate or equivalent
2. A minimum of one-year Healthcare related experience in managed care environment to include but not limited to an IPA or MSO preferred
3. Current knowledge of Managed Care UM and Claims procedures
4. Knowledge of medical terminology, RVS, CPT, HPCS, ICD-10 codes
5. Proficient with Microsoft applications’ and EZCAP
7. Good verbal and written communication skills