Customer Care Associate I

Maryland Heights MO 63043 St Louis 1 14100 Magellan Plaza

Job Description

This position is a frontline service position providing assistance to Magellan's members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.

Essential Functions


- Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
- Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.
- Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
- Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
- Assist in the mentoring and training of new staff.
- Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
- Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
- Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals.
- Educates providers on how to submit claims and when/where to submit a treatment plan.
- Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
- Informs providers and members on Magellan's appeal process.
- Lead or participate in activities as requested that help improve Care Center performance, excellence and culture.
- Links or makes routine referrals and triage decisions not requiring clinical judgment.
- Performs necessary follow-up tasks to ensure member or provider?s needs are completely met.
- Provides information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers.
- Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
- Refers patients/EAP clients to the Magellan's Care Management team for a provider, EAP affiliate, or Facility.
- Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
- Support team members and participate in team activities to help build a high-performance team.
- Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.

General Job Information

Title

Customer Care Associate I

Grade

16

Job Family

Customer Service Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

2/5/2019

Date Requisition Created

2/5/2019

Minimum Qualifications

Education

High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

SERVICE DELIVERY EXPECTATIONS:

Must be customer service oriented, meet Magellan's Service standards in all categories on a monthly basis, team player, maintain member and provider Confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.

MINIMUM REQUIREMENTS:

(Skills necessary to meet minimum performance standards of the position)

1. Education: HS/GED

2. Computer Skills: Must be a proficient typist and able to maneuver through various computer platforms while verifying demographic information on all calls.

OTHER: Excellent verbal and written communication skills, organizational skills required and the ability to handle multiple tasks. Must recognize customer service as an ever-changing environment, this causes one to be flexible in scheduling and having the ability to accept change. Responsible for meeting call handling requirements and daily telephone standards as set forth by the CMC. Must agree to service observing for the purpose of training and quality control.

PREFERRED QUALIFICATIONS: (Additional skills necessary to exceed minimum performance standards)

1. Education: College degree

2. Experience: Experience in a Customer Service/Health Care environment

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

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