Company Overview
CareCounsel, based in California, is a wholly owned subsidiary of Stanford Health Care. Founded in 1996, we developed the nation’s first employer-sponsored health advocacy and healthcare assistance programs, helping employees, retirees, and their families navigate the complex healthcare environment.
Summary
We are seeking a dedicated Care Specialist to join our team in California. This position is responsible for resolving member and provider questions and issues related to the line of business administrative processes, to include claims payment, authorization/referral management, eligibility management, enrollment and member appeals and grievances.
Responsibilities
· Responds to a high-volume of incoming phone calls promptly from members and providers which provides high level customer service. Maximizes “available” time and minimizes delays that may lead to abandoned calls. Verify member eligibility using HIPAA guidelines.
· Resolves issues related to medical claims payment issues, authorization requests, health plan questions, assists with member appeals and grievances, and. kassists members in utilizing appropriate reference materials and policies to research information, respond and resolve customer inquiries.
· Meets and exceeds departmental quality assurance standard.
· Meets and exceeds Likelihood to Recommend (LTR).
· Receptive to coaching/training and responsive to management requests.
· Uses reference documents and online knowledgebase tools to clearly articulate accurate information.
· Identifies urgent customer needs or operational issues and escalates appropriately.
· Documents inquiries in an accurate and timely manner. Stays on top of follow-ups and CRM inventory.
· Uses functionality of the telephone system as required.
· Delivers high-level of customer service.
· Perform related duties as assigned (for example, special projects, covering for an employee).
Education/Experience Qualifications
· High School Diploma or GED Minimum High school Diploma or GED
· Two (2) years of related work experience in a healthcare/benefit setting, preferably in a call center environment.
Required Knowledge, Skills, and Abilities
· Type 40 words per minute.
· Proficient understanding of Medicare basics and Medicare Advantage Plans.
· Employee Benefits and retiree benefits.
· Consumer Driven Health/Account based Plans.
· Claims/Billing.
· Excellent customer service skills.
· Demonstrated knowledge of proper English grammar in speaking and writing.
· Effectively listen to resolve patient's/customers inquiries.
· Maintain respect and composure in stressful situations.
· Navigate complex software tools and accurately input data.
· Effectively document caller notes into the medical record.
· Ability to adjust communication to fit the needs and level of understanding of the receiver.
· Ability to apply business logic to resolve patient/customer issues while managing multiple priorities.
· Working knowledge of EPIC or other patient/customer database.
· Must be able to work all shifts.
· Ability to apply C-I-CARE to work.
Computer/Software
· Microsoft Outlook which includes, Excel, Word, PowerPoint, Teams
Work Environment
· This is a remote position.
· Candidate MUST have high-speed internet connection.
· Candidate MUST have a reliable home-office environment.
· Candidate MUST be on camera during training/work hours, especially during work related meeting.
Physical Demands
- Occasionally required to stand.
- Occasionally required to walk.
- Continually required to sit.
- Continually required to utilize hand and finger dexterity.
- Continually required to talk or hear.
- Continually utilize visual acuity to operate equipment, read
- technical information, and/or use a keyboard.
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing, and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective:
· Know Me: Anticipate my needs and status to deliver effective care.
· Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health.
· Coordinate for Me: Own the complexity of my care through coordination.
Call-To-Action If you are passionate about making a difference in people's lives through effective healthcare advocacy, we invite you to apply today and join our dedicated team at CareCounsel!
Job Type: Full-time
Pay: $27.00 - $31.00 per hour
Benefits:
- 401(k)
- 401(k) 3% Match
- 401(k) matching
- AD&D insurance
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Prescription drug insurance
- Vision insurance
People with a criminal record are encouraged to apply
Work Location: Remote
