Call Center Representative

Duties:
The Customer Services Representative provides comprehensive customer service to members, providers and prospective members.
The primary responsibilities include but are not limited to documenting all customer contacts into the tracking system, process complaints, conduct outreach efforts, assist in PCP selection, conduct new member orientations, claims review inquiries, handle provider and utilization management inquiries, etc.
Record and respond to all Customer contacts and update in tracking system.
Manage and ensure appropriate follow-up and closure for all customer contacts.
Provide on-site as well as telephone orientations to new and existing members.
Process and resolve complaints and record given information in the system.
Assist members with the selection and assignment of PCPs.
Update all member demographic changes.
Provide all benefit/service related information to members, perspective members and providers.
Perform retention efforts for all lines of business.
Handle roster Inquiries
Handle disenrollment inquiries from members, providers and regulatory agencies.
Handle provider inquiries.
Schedule marketing appointments for prospective enrollees
Respond to all claim billing inquiries from providers and members

All other duties and special projects as assigned by Associate Executive Director This is the pay range that RightSourcing (a part of Magnit) reasonably expects to pay someone for this position, however, as a supplier your expected pay range may vary and/or include certain benefits like: Medical, Dental, Vision, 401K [include any compulsory benefits such as commissions, incentive bonuses, etc. if applicable].

This position is responsible for the accurate and timely response to written claim inquiries received from providers.
Incumbent provides support regarding the adjudication and adjustment of claims for the multiple lines of business.
The incumbent works closely with Provider Relations, Medical Management, Member Services and the Claims Processing unit
Act as a key liaison and service representative for all written provider inquiries and problem resolution.
Respond to all claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.
Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, utilization management)
Manage and ensure appropriate follow-up and closure for all inquiries
Respond to Provider Inquiries in writing; maintain accurate files
Data Entry into the IMAX system.
Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
Participate in Special Projects involving Claim Status Investigations.
Resolve Member Bills referred from Member Services.

Skills:
Record and respond to all Customer contacts and update in tracking system.
Manage and ensure appropriate follow-up and closure for all customer contacts.
Provide on-site as well as telephone orientations to new and existing members.
Process and resolve complaints and record given information in the system.
Assist members with the selection and assignment of PCPs.
Update all member demographic changes.
Provide all benefit/service related information to members, perspective members and providers.
Perform retention efforts for all lines of business.
Handle roster Inquiries
Handle disenrollment inquiries from members, providers and regulatory agencies.
Handle provider inquiries.
Schedule marketing appointments for prospective enrollees
Respond to all claim billing inquiries from providers and members
All other duties and special projects as assigned by Associate Executive Director Licensure and/or

Certification Required:
NONE Professional Competencies:
Integrity and Trust
Customer Focus

Functional/Technical Skills:
Written/Oral Communication
In-depth knowledge of MetroPlus Claims Processing protocols and payment schemes.
Thorough knowledge of Plan Benefits.
Proficiency in IMAX and TXEN.
Customer Service Experience a plus.
Must be able to handle irate providers in a professional manner.
Excellent written/verbal communication skills.

Education:
High School graduation or evidence of having satisfactory passed a High School Equivalency Program; and Minimum 1 year experience in a call center environment or a satisfactory equivalent combination of education, training and experience. Proven experience in providing excellent service to customers in various healthcare related areas, (i.e. insurance, doctors office, medical clinics)
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