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Healthcare Customer Care Representative (Remote)

Medical Recruitment Strategies

Healthcare Customer Care Representative (Remote)

Kansas City, MO
Full Time
Paid
  • Responsibilities

    Job Description

    **** THIS IS AN URGENT NEED!!! ****

    POSITION SUMMARY:

    As Customer care Associate, you will:

    • Actively listens and probes callers in a professionally and timely manner to determine 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.
    • Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
    • Assist in the mentoring and training of new staff.
    • Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
    • Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
    • Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan 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 on Magellans appeal process.
    • Lead or participate 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 providers needs are completely met.
    • Provides information regarding Magellans in-network and out-of-network reimbursement rates and states multiple networks to providers.
    • Refers callers requesting provider information to Provider Services regarding Magellans professional provider selection criteria and application process.
    • Refers patients/EAP clients to the Magellans 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.

    QUALIFICATIONS:

    2+ years of Customer Service

    SCHEDULE:

    M-F, 9:30 TO 6:00 P.M.

    Company Description

    Medical Recruitment Strategies (MRS) is a recruiting firm that specializes in the placement of professionals in pharmacies, hospitals, healthcare organizations and life sciences companies. We offer contract and direct hire services and work all over the U.S. Over the last 16 years, we have become a premier provider of talent.