Direct communications with members, providers, and health plans
Confirmation of benefits and eligibility information to members, providers, and health plans
Provide confirmation of participating providers in the network
Provide claim status to members, clients, and providers
Resolve problems by identifying the customer's complaint; selecting and explaining the best resolution for the issue, and escalating to upper management when necessary
Keep managers informed of any issues that may require their attention to avoid or resolve an existing problem
Apply knowledge, experience, common sense, and critical thinking to all issues being dealt with
Multi-task and prioritize
Respond to general inquiries from members and providers (plan benefits, limits, co-pays, deductibles, policy procedures, reimbursements, etc.)
Redirect callers when necessary
Follow up until completion on all issues that are not resolved on the initial contact, and keep parties updated on steps and actions taken
Service the maximum number of callers in the quickest and most efficient way without sacrificing the quality of the service
Job details are sourced from the employer's original posting.
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