Customer Resolution Associate
Harrisburg PA 17112
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
TitleCustomer Resolution Associate
Job FamilyCustomer Service Group
CountryUnited States of America
FLSA StatusUnited States of America (Non-Exempt)
Recruiting Start Date12/4/2019
Date Requisition Created12/4/2019
Work ExperienceClaims, Customer Service
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
ResponsibilitiesMinimum 2 years of claims processing and customer service experience in a high volume, fast-paced health care industry.- 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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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