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Responsibilities:

• Maintains comprehensive understanding of member benefits covered benefits limitations exclusions policies and procedures computer screens and code definitions and maintains current awareness of plan changes and developments.
• Remain current on all departmental policies; procedures plan benefit designs and modifications.
• Coordinates members’ use of the complaint process and assists Members as needed at all levels of the complaint process according to policy.
• Provides information regarding Community Care operations and answers any questions.
• Responds to member inquiries and describes member rights and responsibilities.
• Document inquiries in accordance with Community Care Customer Service guidelines.
• May engage in the acquisition or transfer of structured clinical data but does not engage in any activities that involve clinical evaluation or interpretation.
• Collects information from members concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures to improve the service to members.
• Provides members with updated information changes to the network benefit plan or procedures.
• Makes outreach calls under supervision of care management staff.
• Contacts assigned members for various outreach and follow up initiatives.

Qualifications

• High school diploma or equivalent required some college preferred.
• Proficient in typing required.
• Basic analytical skills necessary to evaluate caller inquiries.
• Strong interpersonal and verbal skills required.
• Ability to work independently required.
• Demonstrates good organizational skills.
• Minimum of 6 months of customer service and/or call center experience behavioral health call center a plus.
• General knowledge of computers required.
• Microsoft windows environment.