Customer Care Associate

Customer Care Associate

This position is a frontline service position providing assistance to members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.

Essential functions include actively listening and probing callers in a professionally and timely manner to determine purpose of the calls. Researching and articulatingly communicating information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality. Resolving customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction. Assisting efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies. Assisting in the mentoring and training of new staff. Assuming full responsibility for self-development and career progression; proactively seeking and participating in ongoing trainings (formal and informal). Comprehensively assembling and entering patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. Demonstrating flexibility in areas such as job duties and schedule in order to aid in better serving members and help company achieve its business and operational goals. Educating providers on how to submit claims and when/where to submit a treatment plan. Identifying and responding to Crisis calls and continuing assistance with the Clinician until the call has been resolved. Informing providers and members on appeal process. Leading or participating in activities as requested that help improve Care Center performance, excellence and culture. Linking or making routine referrals and triage decisions not requiring clinical judgment. Performing necessary follow-up tasks to ensure member or provider’s needs are completely met. Providing information regarding client's in-network and out-of-network reimbursement rates and states multiple networks to providers. Referring callers requesting provider information to Provider Services regarding clients's professional provider selection criteria and application process. Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers. Supporting team members and participating in team activities to help build a high-performance team. Thoroughly documenting customers’ comments/information and forwarding required information to the appropriate staff.

Location: Maryland Heights MO 63043

Duration: Till December, possibility of extension

Spanish plus

All your information will be kept confidential according to EEO guidelines.