Customer Service Associate I - CMC

San Diego CA 92108

Job Description

This position is a frontline service position communicating to Magellan’s members and providers Magellan programs, policies, and procedures. Responsibilities include answering incoming calls on eligibility, benefits, claims, and authorization of services from providers and members. Responsibilities also include the administration of intake documentation in the appropriate systems. Overall, the Customer Service Associate is expected to provide outstanding service to our internal and external customers and strive to resolve member and provider needs on the first call. The CSA provides outstanding service while also achieving operating performance rating of meets or exceeds call center production standards.

Essential Functions

br>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.
Refers patients/EAP clients to the Magellan’s Care Management team for a provider, EAP affiliate, or Facility.
Refers callers requesting provider information to Provider Services regarding Magellan’s professional provider selection criteria and application process.
Links or makes routine referrals and triage decisions not requiring clinical judgment.
Provides information regarding Magellan’s in-network and out-of-network reimbursement rates and states multiple networks to providers.
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.
Educates providers on how to submit claims and when/where to submit a treatment plan.
Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
Thoroughly documents customers’ comments/information and forwards required information to the appropriate staff.
Performs necessary follow-up tasks to ensure member or provider’s needs are completely met.
Lead or participate in Care Management Center activities as requested that help improve Care Center performance, excellence and culture.
Support team members and participate in team activities to help build a high-performance team.
Demonstrate flexibility in areas such as job duties and schedule in order to aid Care Management Center in better serving its members and help Magellan achieve its business and operational goals.
Assist CMC efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
Assume full responsibility for self-development and career progression.
Proactively seek and participate in ongoing training (formal and informal) in all aspects of the Customer Service Associate role.
Assist in the mentoring and training of new CSAs.
Remain responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.


Essential Functions

br>Performs various other duties and special projects that are assigned by management on a daily basis while performing primary functions.
Service Delivery Expectations: Must be customer service oriented, meet Magellan’s Service standards in all categories on a monthly basis, be a team player, maintain member and provider confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.

General Job Information


Customer Service Associate I - CMC



Job Family

Customer Service Group


United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date


Date Requisition Created


Work Experience

Customer Service


GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


Minimum Requirements

Education: HS/GED.

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


Excellent verbal and written communication, organizational and multi-tasking skills.

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 observing service for the purpose of training and quality control.

Preferred Qualifications

Education:  College degree.

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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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