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"Immediate Openings For Customer Service Agent " Pay: $15hr
| Hours | Full-time, Part-time |
|---|---|
| Location | Rancho Cordova, California 95741 Rancho Cordova, California |
About this job
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
��� Customer Service background (ANY)
��� MS Office
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Contact Details:
NATIONAL RECRUITER
STRATEGIC DELIVERY OPERATIONS
214-974-0887 Ext: 57262
Toll Free: 888-767-8704 Ext: 57262
Aerotek is acting as an Employment Agency in relation to this vacancy.