Responsible for inbound phone inquiries primarily dealing with either:
I. Member benefits and eligibility related to the Medicaid, CHP and FHP product lines or
II. Provider benefits, eligibility, PEP and claim status, member pharmacy calls, utilizing prior approval skills (ACP/DME and CCD) and placing outbound calls on a routine basis.
Resolve issues with respect to benefits and eligibility by researching documentation, system information or gaining knowledge from other employees, management or departments.
Interact with customers, document call specifics and demonstrate quality program behaviors to create an outstanding relationship with each caller.
Work with outside vendors as needed to answer questions or resolve issues.
Respond to member correspondence/email in writing utilizing an existing Customer Service system letter to effectively respond to members.
Conduct orientation to new members by providing an overview of the member’s plan and pertaining administrative policy.
Demonstrate awareness, motivation, and technical skills to assist in the development and growth of the customer service teams and help to identify process improvements.
Assist in department/company projects, as needed (i.e. Provide feedback about the customer’s experience)