Call Center Representative - Full-time / Part-time

Job Description:
The Shield Concierge team must be trained and well versed in the appropriate employer groups' specific products, programs, services, network and health management programs to assist members in consultation and referral to programs available to the member.

Job Duties:
* Resolves incoming calls concerning members eligibility, benefits, provider information, clinical and pharmacy needs
* Composes routine and non-routine correspondence to answer benefits/provider inquiries in writing
* Coordinates membership changes such as member's primary care physician
* Comprehensive resolution of pharmacy calls concerning benefit coverage, co-pays, formulary coverage, vacation overrides, and utilization management requirements
* Performs inventory reduction, routine to mid-level, (i.e. member inquiries, may initiate claim adjustments, responds to emails, etc.)
* May participate in quality and efficiency workgroups to continuously improve quality member/customer satisfaction
* Assume Medical Management Clinical Support Coordinator duties in order to create clinical case to transfer to the clinical staff
* Analyze available programs, determine program eligibility and connect member to appropriate BSC vendors, Health Advocates, Social Workers, Pharmacy Techs, and Pharmacists
* Verify the member is included in or targeted for any outreach or care gap programs and connect members to programs or services when appropriate
* Triage cases for assignment to the Shield Concierge Case Management, Behavior Health, Health Management Programs and/or Member Outreach programs and document the status in appropriate systems
* Elevated level of empowerment to resolve disputes prior to escalating to Appeals and Grievances
* Proactively engages member with their wellness plan options
* Enhanced knowledge of medical terminology
* Triage cases to RN's when the case exceeds extension of authority and the criteria is met
* Collaborates with the provider to ensure Continuity of Care is maintained on behalf of the member

About Aerotek:

Our people are everything. As a Best of Staffing® Client and Talent leader, Aerotek® Inc. has distinguished itself as a leader in recruiting and staffing services, by having a deep understanding of the intersection of talent and business. As a strategic partner to more than 17,000 clients and 300,000 contract employees every year, Aerotek's people-focused approach yields competitive advantages for its clients and rewarding careers for its contract employees. Headquartered in Hanover, Md., Aerotek operates a network of over 230 non-franchised offices with more than 6,000 internal employees dedicated to serving our customers. Aerotek is an operating company of Allegis Group, a global talent solutions provider. To learn more, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.