Job Discription
REQUIRED QUALIFICATIONS:
-High School Diploma/GED (or higher) or equivalent work experience
-Minimum of 2+ years of combined education, work and/or volunteer experience
-Work from home with a dedicated work area separate from other living areas to provide information privacy
-High-speed internet connection service, a must
-Strong computer and software navigation skills
PREFERRED QUALIFICATIONS, A PLUS:
-Customer service experience
-Familiarity with medical terminology, health plan documents, or benefit plan design in a healthcare/insurance environment
-Experience in social work, behavioral health, disease prevention, health promotion and behavior change, working with vulnerable populations
-Sales or account management experience
PERSONAL CHARACTERISTICS:
-Efficient, detail-oriented, thorough, and productive; outstanding telephone skills
-Patient-focused and adaptable to changes; proactive
-Ability to work independently or with a team
-Ability to make fact-based decisions and deliver quality results
PRIMARY RESPONSIBILITIES:
-Serve as a single point of contact for the customer, providing outstanding telephonic customer service with resolution
-Research complex issues and work with support resources to respond to customers’ inquiries and issues, own the resolution, and anticipate future healthcare needs
-Identify gaps in processes, close gaps in care for the member and/or the member’s family, working closely with other departments for process improvement
-Address complex questions, refer care for medical, dental, flex, pharmacy benefits, eligibility and claims, financial spending accounts, and correspondence
-Provide education and status on previously submitted pre-authorizations or pre-determined requests
-Meet performance goals of efficiency, call quality, customer satisfaction, first call resolution and attendance.
-Perform all other duties as assigned
BPC is an equal opportunity employer.
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