To provide high-level customer service to PDTs’ clients with accuracy.
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Principal Duties and Responsibilities - *Goals on Performance Review
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Answer calls from members, providers, and health plans regarding specific claim issues. Route and redirect calls as necessary.
- Return calls from the UM voicemail box within 24 hours
- Perform timely follow-up on calls requiring research and call back within 24 hours.
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Accurately interpret DOFRs – Division of Financial Responsibility documents to determine where specific health care services are rendered.
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Verify eligibility & benefits for each submitted physician referral by contacting health plans for pertinent information.
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Work with contracting personnel to ensure the utilization of appropriate providers.
- Provide requested referral and network information to providers/staff promptly within 24 hours.
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Use MedMC to log incoming calls and their resolution.
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Complete other projects as assigned by the supervisor
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Job Specifications (KSAs):
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Requires the ability to speak, read, write, and understand English and other general educational skills, as is generally obtained by completing high school or a GED.
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Knowledge of the health or managed care industry is generally obtained through 1-2 years of work experience.
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Excellent communication skills with a focus on superior telephone etiquette.
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1-2 years of customer service experience required.
IV Position Performance Criteria
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Ability to organize and maintain multiple sets of information and data.
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Consistently produces accurate and timely work as it relates to departmental goals.
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Demonstrates high reliability through consistent punctuality and attendance.
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Competently performs position requirements with minimal supervision and direction, including taking initiative and assuming responsibility for follow-through.
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Uses sound judgment regarding time management and prioritization of work to balance multiple tasks and meet required timeframes for all administrative activities as required.
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Demonstrates excellent interpersonal skills as discerned through observation and team project successes.
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Accurately interprets and applies departmental policies and procedures using sound judgment.
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Communicates professionally and respectfully with peers, superiors, subordinates, and clients.
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Provides constructive feedback on assigned work projects.
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Demonstrates overall professionalism in attitude, demeanor, and personal appearance.
