Description

• Maintains comprehensive understanding of member benefits, covered benefits, limitations, exclusions, policies and procedures, computer screens and code definitions, and maintains current awareness of plan changes and developments.
• Remain current on all departmental policies; procedures plan benefit designs, and modifications.
• Coordinates members' use of the complaint process and assists Members, as needed, at all levels of the complaint process according to policy.
• Provides information regarding Community Care operations and answers any questions. Responds to member inquiries and describes member rights and responsibilities.
• Document inquiries in accordance with Community Care Customer Service guidelines.
• Facilitates members' access to services by scheduling appointments or arranging transportation through the Medical Assistance Transportation Program or the PHMCO, when needed.
• Conducts self in a manner consistent with the mission and philosophy of the organization at all times.
• Receives member and provider complaints, attempts resolution, and logs data.
• Provide exemplary customer service by being proactive and responsive to all Community Care member requests.
• Works with the care management staff, and other staff as appropriate, to develop necessary materials; special projects;member/provider alerts; and ability to discuss new procedures with members and providers.
• Interacts and coordinates with all areas of the organization.
• May engage in the acquisition or transfer of structured clinical data, but does not engage in any activities that involve clinical evaluation or interpretation.
• Collects information from members concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures to improve the service to members.
• Provides members with updated information, changes to the network, benefit plan or procedures.
• Makes outreach calls under supervision of care management staff.
• Contacts assigned members for various outreach and follow up initiatives.
• Determines if the member needs intervention by the Care Manager for emergent or urgent situations as directed by protocol.

Qualifications

• High school diploma or equivalent required, some college preferred.
• Minimum of 6 months of customer service and/or call center experience, behavioral health call center a plus.
• 2 years of customer service and/or call center experience strongly preferred.
• Proficient in typing required.
• Basic analytical skills necessary to evaluate caller inquiries.
• Strong interpersonal and verbal skills required.
• Ability to work independently required.
• Demonstrates good organizational skills
• General knowledge of computers required.
• Microsoft windows environment

Salary Range: $14.97 to $23.54 / hour

Union Position: No