Temp to Perm - Non-Clinical - Customer Service Representative (Days)

Remote with onsite/virtual training. Work from home position after training completion

This position will be responsible for daily member telephone calls which will include directing members to the proper services needed, educating members, problem solving, and creating linkages to the Medical Management Department for authorization of services. Also may be responsible for assisting providers with eligibility, benefit, and resolution of claims issues.

Responsibilities:

• Meet the Department standard of calls answered, and call documentation entered.
• Assist Members and Providers with questions and concerns.
  
  

Finding Provider(s)/Services for members

Arrange Transportation for members

Answer billing/claims status questions; resolve claim issues for members

Assist with pharmacy issues

Help Members access community support services

Verify member eligibility

Quote benefits

Assist with Referrals

Assist with member health assessments

Assist members with closing gaps in care

• Ongoing member education.
• Responsible for all benefits information given to Members and Providers.
• Participate in Departmental Projects, as appropriate.
• Coordinate quality improvement initiatives with Medical Management, Provider Relations, and Quality Depts., i.e., Preventative Health Screenings.
• Other duties as assigned or when necessary to maintain efficient operations of the department and the Company as a whole.
  
  

Submission Requirements

1 Years of Experience - Required

Needs to be Hakha Chin Burmese speaking - Required - please notate in Profile

High School Diploma - Required - proof not needed in submission

1+ year in a call center - Required

Bilingual applicants preferred-eligible for *** increase in pay rate

Candidates must reside in Indiana- Required

Health system-wide profile standards

References NOT required.

A skills checklist completed within one year of application for RN specialties is required. All other professions outside of Nursing are not required but preferred.

Michigan license verification is required for nurses. Please provide LARA and Nursys; if there is a license hit, it would be in the traveler’s best interest to provide a write-up of what happened for the manager's review.

Physical copies of certifications are only required in the profile if listed above.