Brooklyn NY 11201
Job DescriptionThis position is responsible for providing assistance with the resolution of authorization and/or claim issues in various work queues resulting from and calls taken from facilities and providers. Acts as liaison between providers, internal departments and specific accounts, clients, and claims department.
- Resolves cases in queue due to member eligibility issues, referring provider verification or request, imaging provider verification, redirection, and retro reviews. Assists with authorization problem resolution through research and facilitating the resolution of the problem in a timely fashion.
- Process, forward, trend, and maintain records of authorization issues. Acts as a troubleshooter to resolve problems among internal departments.
- Handles special requests from Customers requiring manual workarounds or specials projects.
- Investigates written/verbal complaints involving authorizations, and resolves complex issues with Customers and Providers.
- Assists specific accounts who have special processes.
- Observes and tracks authorization problem trends and works with internal department for resolution.
- Assists with User Acceptance Testing (UAT).
- Provides phone back-up coverage for other teams as needed.
General Job Information
Job FamilyCustomer Service Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date7/9/2018
Date Requisition Created7/9/2018
EducationA Combination of Education and Work Experience May Be Considered.||&& Bachelors
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- Ability to review and interpret multiple contract/account information to successfully resolve issues regarding benefit plan administration; experience with account benefit structures.
- Demonstrated ability for problem solving, meeting deadlines, initiative and follow-through.
- Excellent written and verbal communication skills.
- Knowledge of pharmacy benefits management.
- Understanding of customer service performance metrics (ASA, abandonment rate, talk time).
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
Top 5 reasons to work at Magellan
Meaningful Work With People Who Care
At Magellan Health you can do meaningful work and feel confident that you matter in an organization that makes a real difference in the world - one that cares deeply and uses its employees’ collective insight as a competitive advantage.Read More
We are Compassionately Curious
Magellan Health is a place where we listen with real empathy. It’s one of our biggest strengths. It helps us to support each other and develop innovative solutions for the fastest growing, most complex areas of healthcare.Read More
We are Better Together
We rely on our innate ability to work as a high-functioning collaborative team to facilitate compassionate care to all of our members. With such interdependency comes trust, challenge and innovation.Read More
We believe work and life should flow together in unison. We offer resources that match your professional development, a culture that welcomes your ideas, and unparalleled flexibility to fit work around your life.Read More
Be your best at Magellan Health. We’re a collective of remarkably motivated and driven professionals. As a team, we’re proud of the high standards we set for each other and we’re continually inspired to do our best work.Read More