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Summary of Position:
This position is responsible for receiving, researching and documenting member and provider inquiries (written, telephonic and electronic) and member grievances, receiving and making outbound calls to members regarding health risk assessment and working aged surveys, and assisting operations area as needed from a secure remote work location.
The position requires learning federal & state regulations, and being able to apply those regulations to internal policies and procedures.
Principal Duties of Position:
Ø Receive, research, resolve and document member and provider inquiries
Ø Receive, research, and respond to client inquiries
Ø Receive, research, resolve and document member grievances
Ø Receive, identify, document and route member appeals to client
Ø Receive telephone inquiries regarding health risk assessment and working aged surveys
Ø Contact health risk assessment and working aged non-respondents by telephone
Ø Ensure compliance with state and federal laws
Ø Maintain effective communication with customers, team members and management staff from a secure remote work location.
Ø Assist operations area as needed.
Description of Skills Required to Perform this Job:
Ø Minimum of 1 years call center experience (TMG or external).
Ø Customer service and or health care related experience helpful
Ø Excellent communication skills
Ø PC Experience – MS Word, Excel, Outlook
Ø Excellent telephone skills
Ø Ability to concentrate despite distractions.
Ø Ability to work independently without supervision.
Ø Ability to separate work from other obligations (e.g. family, friends, school, etc.).
Ø History of completing work assignments on time and without reminders.
Ø History of compliance with Company policies and procedures.
Ø Ability to use good judgment, make sound decisions and use logical reasoning.
Ø Excellent attention to detail
Ø Ability to type 30 words per minute with accuracy.