Job Description

Duration: 6-month contract

JOB DESCRIPTION:

• Actively listens and probes callers in a professionally and timely manner to determine the purpose of the calls.
• Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assists in the mentoring and training of new staff.
• Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
• Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care, and Utilization management programs.
• Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help achieve its business and operational goals.
• Educates providers on how to submit claims and when/where to submit a treatment plan.
• Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
• Informs providers and members of the appeal process.
• Leads or participates in activities as requested that help improve Care Center performance, excellence, and culture.
• Links or makes routine referrals and triage decisions not requiring clinical judgment.
• Performs necessary follow-up tasks to ensure member or provider needs are completely met.
• Provides information regarding in-network and out-of-network reimbursement rates and states multiple networks to providers.
• Refers callers requesting provider information to Provider Services regarding professional provider selection criteria and application process.
• Refers patients/EAP clients to the Care Management team for a provider, EAP affiliate, or Facility.
• Responsible for updating self on ever-changing information to ensure accuracy when dealing with members and providers.
• Support team members and participate in team activities to help build a high-performance team.
• Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.

RESPONSIBILITIES:

• Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
• Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
• Must agree to observe service for the purpose of training and quality control.
• Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
• Must be able to maneuver through various computer platforms while verifying information on all calls.
• Must be able to talk and type simultaneously.

WORK EXPERIENCE:

• Customer Service

EDUCATION:

• High School Diploma or GED (Required)
• Associates (Preferred), Bachelors (Preferred)

Company Description

Astyra Corporation is a staffing and consulting company that is locally owned and operated right here in the heart of RVA. Astyra offers a unique approach to solving the business challenges of its clients. After being in business for over 20 years, we have evolved and grown - smart ideas, ingenuity and never settling for failure are our hallmark traits. We are locals with a national presence and need a like-minded; client-focused professional who wants to make a difference every day.