Lea Pointer

Responded to inquiries via calls covering all product lines for members, potential clients, providers and their advocates.

Handles and resolves member issues, assists members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc.

Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc. Assists providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility.

Documents all calls via the member data base systems. (QMEIS). Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (60%)

Processes payments for L.A. Care Covered

• Handle a high volume of inbound and outbound calls, assisting patients or members with inquiries related to healthcare services, insurance coverage, and billing
• Provide accurate information regarding healthcare plans, benefits, and eligibility requirements
• Schedule appointments, process referrals, and coordinate care between providers and patients
• Resolve customer issues efficiently, including complaints or discrepancies related to claims or service delivery
• Document all customer interactions and updates in the system accurately and in compliance with HIPAA and company policies
• Collaborate with internal departments to address and escalate unresolved concerns, ensuring a seamless customer experienc