Position Summary/purpose:
This position requires a highly skilled, knowledgeable and qualified candidate. This position will support and assist supervisor and team lead in developing programs and procedures to enhance productivity and performance within the Customer Experience department. This position will assist in a variety of areas helping the organization in delivering outstanding customer support and develop customer relationships. This position serves as a liaison between Customer Experience and cross-functional areas.
Essential Duties and Responsibilities:
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Thoroughly understands the managed care philosophy and the company’s products.
- Receives and responds to member and provider phone calls/inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
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Answers calls in a pleasant and courteous manner within 30 seconds.
- Spearhead special projects, testing of new products/services, new employee/refresher training and serves as Dept SME on all products and services.
- Exercises initiative, judgement, discretion and decision-making abilities in order to achieve organizational objectives.
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Communicates with other departments and management to resolve problems and expedite work.
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Addresses escalated member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
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Works with leadership team in the creation and maintenance of training manuals, SOP’s and P&P’s.
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Accurately documents member and provider contacts on the computer system.
- Communicates effectively and professionally with members, providers and state agencies.
- Screens telephone calls and directs to the appropriate area or person as necessary.
- Works in coordination with other departments concerning member and provider issues.
- Prepares documentation and reports for review by the Member Services Director and Supervisor.
- Responds to written inquiries through the member portal.
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Maintains confidentiality per HIPAA guidelines.
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Other duties as assigned.
This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.
Skills and Abilities:
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Verbal and written communication skills.
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Ability to work independently.
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Ability to meet deadlines.
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Ability to maintain a good rapport and cooperative working relationship with team.
Work Schedule:
As a continued effort to provide a safe and productive work environment, Community Care Plan is currently following a hybrid work schedule. Staff are able to work from home 3 days a week and will report to the office 2 days a week. *****The company reserves the right to change the work schedules based on the company needs.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 15 pounds.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job. The noise level in the work environment is usually moderate.
We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.
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High school diploma or general education degree (GED); and two to four years related experience and/or training; or equivalent combination of education and experience.
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Knowledge of word processing software, spreadsheet software, internet software and Epic software.
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Minimum of 6 months in current position.
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Must be versed in all lines of business and knowledgeable of all department’s functions and responsibilities.
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Must be in adherence within all defined performance metrics requirements
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Must be proactive, able to take initiative, and operate on an independent basis.
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Must be able to complete all assigned tasks, projects and deliverable in a timely manner.
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Must be able to multi-task and perform under stressful conditions.