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Hours Part-time, Full-time
Location 300 Continental Blvd
El Segundo, California

About this job

Job Description

Starting Salary, $14.00/hour

The SBU Provider Services Associate I works on an operations team that strives to provide first call resolution to a specified set of customers. This position primarily answers incoming calls for new and existing authorizations. Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers. This PSA is expected to meet or exceed operations production and quality measures.
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Essential Functions:

Understands the end to end authorization process, SBU's business and business drivers for success.
Actively listens and probes callers in a professional and timely manner to process authorizations and/or other customer service requests working towards first call resolution.
Researches and communicates information regarding member eligibility, provider status and authorization inquiries to callers while maintaining confidentiality.
Resolves customer complaints or concerns as the first line of contact.
Makes problem resolution and triage decisions not requiring clinical judgment.
Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
Transfers calls to clinicians and physicians only for clinically escalated situations.
Communicates appeal and denial language to providers and members when appropriate.
Processes withdrawals and other case status changes as needed.
Understands client and regulatory expectations for accounts in their designated region.
Recognizes and develops relationships with provider groups through repeat calls, and recognizes provider sensitivities for different health plans.
Is responsible for reading and retaining information disseminated through multiple sources, i.e. Achieve, training alerts, NIAssist, emails, training classes, etc. Calls are handled accurately and appropriately per current account information.
Processes fax attachments in between calls.
Responsible for meeting SBU's Service standards in all categories on a monthly basis, team player, maintain member and provider Confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.
Participates in SBU's Service Operations activities as requested that help improve Care Center performance, excellence and culture.
Support team members and participate in team activities to help build a high-performance team.
Demonstrate flexibility in areas such as job duties and schedule in order to aid SBU's Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.
Assist SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assume responsibility for self-development and career progression.
Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Customer Care Associate role.

Non-Essential Functions:

Other projects and duties as assigned by supervisor. According to departmental needs, employees may be on the phone up to 90% of the day and complete other essential functions on an as-needed basis.

Other:

Excellent verbal and written communication skills, organizational skills required and the ability to handle multiple tasks.
Must recognize customer service as an ever-changing environment, this causes one to be flexible in scheduling and having the ability to accept change.
Must be able to solicit appropriate information and make decisions within scope of the position.
Must agree to service observing for the purpose of training and quality control