Customer Resolution Associate

Harrisburg PA 17112

Job Description

This 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


Customer Resolution Associate



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

Claims, Customer Service


Bachelors (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


Minimum 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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