The primary function of this position is to research and resolve eligibility verification requests in an appropriate and timely manner.
· Researches and resolves member eligibility requests. Must maintain minimum production levels with no less than 98% accuracy.
· Follows confidentiality guidelines to ensure security measures are enforced and proprietary information is protected.
· Verifies member eligibility from eligibility tape, communications log, health plan websites or by calling the health plan directly when all other resources are exhausted.
· Inputs and saves verified member’s information into the communications log and/or member maintenance.
· Ensures the highest quality of customer service by maintaining a professional and courteous manner.
· Processes research immediately to ensure turn around time is met.
· Makes follow up calls same day to providers and members to give results of research.
· Transfers providers to provider queue if question is not related to eligibility.
· Transfers members to member queue if caller has detailed questions or wishes to file a complaint.
· Processes research within 24 hours to ensure 48 hour turn around time is met.
· Builds or updates member and group records including documentation in notes.
· High School diploma or equivalent.
· Two years experience with 10 key, typing, and computer skills. 8,000-10,000 key strokes per hour.
· Excellent customer service skills, experienced in making outbound calls and meeting expectations for productivity and accuracy required.
· Experience with claims processing or eligibility verification preferred.
· Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
· Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
· Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
· Ability to effectively organize, prioritize, multi-task and manage time.
· Demonstrated accuracy and productivity in a changing environment with constant interruptions.
· Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
· Ability to exercise strict confidentiality in all matters.
Mobility: Primarily sedentary, able to sit for long periods of time.
Physical Requirements: Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility, within region, and nationally by car and plane as needed. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions: Usual office setting.