• Maintain member satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
• Answer member telephone calls promptly to avoid on-hold wait times.
• Offer advice and assistance to members, paying attention to special needs or wants.
• Use company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
• Work with clients to improve life choices and maximize benefits of programs
• Manage members calls effectively and efficiently in a complex, fast-past and challenging call center environment
● Accurately document, research and resolve member service issues
● Provide professional, courteous and accurate benefit information to all members
● File and process member insurance claims
● Referrals and prior authorizations
● Grievance/Appeals
● Educate members on all aspects of the plan(s) including answering questions regarding plan feathers and benefits.
● Navigate through multiple system applications to fulfill caller requests, update caller information
● Comply with performance standards for work quality, work efficiency, attendance, and schedule adherence
● Resolved Claims quickly through meticulous research
● Streamline operational efficiencies by researching problems and delivery speedy issues resolution
● Breaking down complex health care information so it is clear to members