Call Center Representative

• Provide customer service for patients regarding triage, scheduling appointments, referrals, messaging, and maintaining patient demographics
• Respond to incoming calls using skill-based technology while meeting quality standards and performance measurements
• Conduct outbound calls as required and meet established quality and quantity guidelines
• Develop and maintain positive customer and partner relationships
• Act as a member/patient advocate with practitioners, employer groups, and brokers
• Support process and procedure documentation and functional process improvements
• Identify patterns in call inquiries and grievances and conduct root cause analysis
• Research inquiries and special projects and provide accurate benefit interpretation and timely resolutions
• Participate effectively in individual, team, and process improvement initiatives
• Record calls, mail, email, faxes, and walk-in encounters in appropriate databases for analysis and reporting
• Coordinate meetings with customers or partners for training, contracting, and reporting
• Perform other functions as required

Call Center Representative – Patient Services

• Provide customer service to patients regarding scheduling appointments, referrals, messaging, patient triage, and maintaining patient demographics
• Respond to incoming calls routed through skill-based technology
• Conduct outbound calls as required
• Resolve contacts on the initial encounter while meeting quality standards and performance measurements
• Develop and maintain positive customer and partner relationships
• Act as a member/patient advocate with practitioners, employer groups, and brokers
• Support process improvements by documenting processes and procedures
• Identify patterns in call inquiries and grievances
• Conduct root cause analysis in resubmitted and adjusted claims
• Research inquiries and special projects and communicate accurate benefit interpretations and resolutions
• Record calls, mail, email, faxes, and walk-in encounters in appropriate databases
• Assist with coordinating customer or partner meetings for training, contracting, and reporting
• Participate in internal teams, process improvement teams, and initiatives
• Perform other functions as required