Customer Care Associate II (Bilingual)
Bridgewater MA 02324 One Lakeshore Center
Job DescriptionBilingual ability, particularly Cape Verde Creole/Portuguese/Spanish, strongly preferred.
This shift is 12pm-8pm.
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.
- 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
TitleCustomer Care Associate II (Bilingual)
Job FamilyCustomer Service Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date1/21/2019
Date Requisition Created1/21/2019
EducationGED (Required), High School (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
ResponsibilitiesMust be flexible in scheduling and comfortable with change as customer service is an ever-changing environment. Responsible for meeting call handling requirements and daily telephone standards as set forth by management. Must agree to observing service for the purpose of training and quality control. Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills. Must be able to maneuver through various computer platforms while verifying information on all calls. Must be able to talk and type simultaneously.
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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