Description:Responsible for communicating with physicians and patients regarding plan benefits and eligibility. This position emphasizes member education, customer service and front line problem solving. Expect to handle 60 calls daily. ESSENTIAL DUTIES AND RESPONSIBILITIES:
Thoroughly understands the managed care philosophy and the company’s products.
Receives and responds to member and provider phone calls/inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
Receives, records, and resolves member complaints and problems.
Answers calls in a pleasant and courteous manner within 30 seconds.
Routinely accesses member information via multiple computer systems.
Accurately documents member and provider contacts on the computer system.
Responsible for ensuring that members receive accurate and complete information.
Communicates effectively and professionally with members, providers and state agencies.
Screens telephone calls and directs to the appropriate area or person as necessary.
Acts as a liaison between members, physicians and health plan.
Researches member concerns and attempts to resolve issue during call.
Works in coordination with other departments concerning member and provider issues.
Prepares documentation and reports for review by the Member Services Director and Supervisor.
Maintains confidentiality per HIPAA guidelines.
Additional Skills & Qualifications:2+ years of strong computer skillsAbility to communicate with doctors, physicians and registered nurses on a daily basis.Ability to multi-task, candidate will be required to manage a high volume of cases and referrals per day.About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.