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Customer Care Representative

Wollborg Michelson Recruiting Rancho Cordova, CA

  • Expired: over a month ago. Applications are no longer accepted.
Job Description

* MUST BE FULLY VACCINATED PRIOR TO START DATE*

 

Job Summary 

As a Customer Care Representative (CCR), you are in charge of upholding our mission of providing service worthy of our family and friends. Our priority is for our members to experience the upmost of care and compassion by conveying empathy and resolving all issues and helping them get back to enjoying their lives as quickly and effortlessly as possible. You are empowered to provide members with peace of mind that their current issue is resolved and that none are on the horizon. 

 

Successful CCRs Deliver An Effortless Customer Experience By 

• Taking the lead – our CCRs take ownership of members’ issues, relieving members’ stress while guiding them to a quick and easy resolution. 

• Identifying future problems – not only do our CCRs solve the current member concern but they actively identify and solve any lurking complications the member may encounter after their first interaction. 

• Sharing insights with peers and management – our positive team culture relies on open communication to continuously improve how our work gets done. 

• Having fun! – our work is important, but we don’t take ourselves too seriously. We love helping others and have a fun community dedicated to doing so! Who We’re Looking For In the Customer Care team, we value our employees as much as our members. This job isn’t for the faint of heart. No two members, problems, or resolution journeys are the same. Sometimes you won’t know the right answer, but we’re looking for someone who is always up for the challenge. Our team members are the kind of people who create a plan and take charge in situations where others feel lost. If you excel at figuring out logic puzzles, welcome challenges, and have a passion around helping others in what could be their most vulnerable moment, then we bet you have the right stuff! We’re Looking For People Best Described As 

• A proactive, solution-oriented decision maker • A planner, multi-tasker, and expert problem solver 

• Outspoken, with a “can-do” attitude and infectious positivity 

• A compassionate individual who can convey empathy Responsibilities • Resolves incoming calls concerning members eligibility, benefits, provider information, monthly premium billing, clinical and pharmacy needs. 

• Composes routine and non-routine correspondence to answer benefits/provider inquiries in writing. 

• Coordinates membership changes such as member's primary care physician. 

• Performs inventory reduction, routine to mid-level, (i.e. member inquiries, may initiate claim adjustments, responds to emails, etc.) 

• Reviews and analyzes member claims for accuracy as well as member education on how benefits are applied. 

• Participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction as requested. 

• Proactively analyze available programs, determine program eligibility and connect member to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists. Verify the member is included in or targeted for any outreach or care gap programs and connect members to programs or services when appropriate. Engage members with their wellness plan options. 

• Enhanced knowledge of medical terminology. 

• Comprehensive resolution of pharmacy calls concerning benefit coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements. 

• Provide prescription related benefit coverage (e.g. explanation of coverage or benefit summary related): Provide prescription co-pays. Provide prescription formulary coverage information and utilization management requirements using web posted printed formulary. Provide a brief description of coverage denial reason and alternatives as listed in the printed formulary. Perform prescription claim overrides. 

• Provide deductible and max out of pocket information. 

• Provide status of a prior authorization requests. • Assist members may when and how to appeal a coverage decision. 

• Other duties as assigned. Knowledge And Experience 

• Requires basic job knowledge of systems and procedures obtained through prior work experience or education. 

• Typically, requires minimum of 3 years of experience. 

• May require vocational or technical education in addition to prior work experience

 

OSHA ETS/Federal Mandate, Wollborg Michelson does require all applicants to be able to provide proof that they are fully vaccinated from COVID prior to their start date, unless otherwise prohibited by law

 

Wollborg Michelson Recruiting

Why Work Here?
Company provides STRONG healthcare benefits, Dental, Vision, PTO and 401k

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Rancho Cordova, CA
95742 USA

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