Customer Care Associate II (Bilingual)
Bridgewater MA 02324 One Lakeshore Center
Job DescriptionCandidates must be available to work 37.5 hours/week between 12pm and 11pm Monday-Friday. Bilingual candidates are strongly preferred, particularly fluency in one of the following combinations of languages:
-English/Spanish/Portuguese/Cape Verdean Creole
-English/Cantonese or Toishanese
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.
- 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.
- Assists in the mentoring and training of new staff.
- Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
- Assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
- Demonstrates 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.
- Leads or participates 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.
- Updates self on ever changing information to ensure accuracy when dealing with members and providers.
- Supports team members and participate in team activities to help build a high-performance team.
- 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 Date7/8/2019
Date Requisition Created7/8/2019
Work ExperienceCustomer Service
EducationGED (Required), High School (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
Must 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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
Top 5 reasons to work at Magellan
Meaningful Work With People Who Care
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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
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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