Customer Care Associate I Remote In California

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Customer Care Associate I Remote in California
Summary
This position is a front-line service position providing assistance to Magellan's members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.

• Provides information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers.
• Educates providers on how to submit claims and when/where to submit a treatment plan.
• Assists in the mentoring and training of new staff.
• Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Leads or participates in activities as requested that help improve Care Center performance, excellence and culture.
• Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
• Performs necessary follow-up tasks to ensure member or provider needs are completely met.
• Links or makes routine referrals and triage decisions not requiring clinical judgment.
• Support team members and participate in team activities to help build a high-performance team.
• Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
• Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Refers patients/EAP clients to the Magellan's Care Management team for a provider, EAP affiliate, or Facility.
• Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
• Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
• Informs providers and members on Magellan's appeal process.
• Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
• Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
• Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
• Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).

Responsibilities

• Must agree to observing service for the purpose of training and quality control.
• Must be able to talk and type simultaneously.
• Responsible for meeting call handling requirements and daily telephone standards as set forth by management.
• Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
• Must be able to maneuver through various computer platforms while verifying information on all calls.
• Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.

Work Experience
Work Experience - Required
Customer Service
Work Experience - Preferred
Education
Education - Required
GED, High School
Education - Preferred
Associates, Bachelors
Certifications
Certifications - Required
Certifications - Preferred:
Potential pay for this position ranges from $13.90 - $20.85 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.