The Customer Service Representative is the front line interface to Members and Providers with behavioral health needs. The Customer Service Representative assists callers by providing benefit and eligibility information and referrals to network providers. The Customer Service Representative transfers clinical calls to clinicians, as defined in the transfer protocol. In addition, the Customer Service Representative will be responsible for completing specified assignments that assist the department in meeting contractual goals
1. Staff all Member Service ACD queues and adhere to telephone performance requirements for call response times and abandonment rates
2. Respond to member requests to access behavioral health services and for referrals to network providers
3. Determine which calls need to be transferred to a clinician, as defined by established protocols, including emergency call procedures
4. Verify member’s health Insurance coverage when necessary
5. Prepare daily correspondence for mailing including prior authorization determination, member and provider educational material, etc.
6. Perform data entry of specified authorization requests or other data entry and reporting as needed.
7. Outreach to new members that have been identified with behavioral health needs.
8. Other duties as assigned, including but not limited to
- Participation in Quality Improvement Teams and/or projects
- Back up coverage for Aftercare coordinator
- Assist in training of new staff
High School Diploma or GED Required.
Some secretarial, general office and/or call center experience preferred. Working knowledge of modern office methods and procedures including filing systems, telephone techniques, letter and report writing, preferably in a health care related setting.
Must be well organized. Position requires excellent phone manners and Intermediate level of computer and typing skills
COMPREHENSIVE CARE SINCE 1996
In close partnership with health plans, we help bring together the fragmented pieces of healthcare to achieve...