Job Description

Position : Inbound Call Center Agent

Location : Fully Remote

Duration : Permanent Hire

Experience : 1-3 YEARS

Mandatory Skills : Provider Inbound

JOB DESCRIPTION

As a Health Insurance Customer Service Advocate, you will work with members and health providers for Prior Auth creation and review pending statuses. This position helps to enroll our members into CMC programs such as cancer, kidney, artificial hearts, ortho etc. You will review if the member's policy have access, review qualifications, inform what program are available for them and set up appointments with providers.

**The position is remote but does require you to be available to work 8 hours per day - Monday thru Friday 7am-7pmCST.**

Roles & Responsibilities:

• This is a call center production role and you will have the responsibility to meet production, quality and regulatory expectations.
• Ensure case is set up correctly and document required information.
• Review, research and determine if case can be decisioned or if it requires additional clinical review.
• Demonstrate proficiency and decision making by solving complex problems using available resources (documents, medical policy, standard operating procedure, etc.)
• As needed, make outbound calls to providers and/or members to obtain information regarding a case.
• As needed, make outbound calls to providers to coordinate provider availability in treating members.
• Other duties as assigned by manager and/or director.

Qualifications Required:

• Minimum of a High School Diploma/GED Verifying document will be required.
• 1+ years of professional experience in a medical or health insurance environment.
• Prior customer service experience making outbound calls.
• Proficiency in using a computer.
• Experience working with Microsoft Office Products including Microsoft Outlook, Microsoft Word and Microsoft Excel (ability to create, edit, save, and send spreadsheets).
• Ability to work an eight (8) hour shift Monday-Friday between 7am-7pm CST.
• Flexibility to work outside standard hours of operations due to changing business needs.
• Ability to trouble shoot and setup computer equipment independently.
• Must have a designated work area established that is separate from other living areas and can be secured to maintain PHI or PI security in line with HIPPA policies and standards.
• Remote but MUST live in a location that can receive a dedicated hard-wired high-speed internet connection or leverage an existing high-speed internet service provider (ISP) with a minimum speed 2mps upload/ download speed.

Soft Skills:

Strong communication skills; Written and verbal.

Excellent critical thinking and problem - solving skills.

Candidate needs to be highly organized.

Analytical, problem solving and decision-making skills; ability to exercise good judgment.

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