Inbound Customer Service Representative (Provider Services)

Phoenix AZ 85034

Job Description

This is an in-office position- Candidates must be available to work between 6am and 6pm Monday-Friday.

This position is part of an operations team that strives to provide first call resolution to a specified set of customers. This position primarily answers incoming calls for new and existing authorizations. Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers. This role is expected to meet or exceed operations production and quality measures.
  • Understands the end to end authorization process, the SBU's business and business drivers for success.
  • Actively listens and probes callers in a professional and timely manner to process authorizations and/or other customer service requests working towards first call resolution.
  • Researches and communicates information regarding member eligibility, provider status and authorization inquiries to callers while maintaining confidentiality.
  • Resolves customer complaints or concerns as the first line of contact.
  • Makes problem resolution and triage decisions not requiring clinical judgment.
  • Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
  • Transfers calls to clinicians and physicians only for clinically escalated situations.
  • Communicates appeal and denial language to providers and members when appropriate.
  • Processes withdrawals and other case status changes as needed.
  • Understands client and regulatory expectations for accounts in their designated region.
  • Recognizes and develops relationships with provider groups through repeat calls, and recognizes provider sensitivities for different health plans.
  • Is responsible for reading and retaining information disseminated through multiple resources, ensuring calls are handled accurately and appropriately per current account information.
  • Processes fax attachments in between calls.
  • Responsible for meeting SBU's Service standards in all categories on a monthly basis, team player, maintain member and provider Confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.
  • Participates in SBU's Service Operations activities as requested that help improve Care Center performance, excellence and culture.
  • Supports team members and participate in team activities to help build a high-performance team.
  • Demonstrates flexibility in areas such as job duties and schedule in order to aid SBU?s Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.
  • Assists SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
  • Assumes responsibility for self-development and career progression.

General Job Information


Inbound Customer Service Representative (Provider Services)



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, Healthcare


GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


  • Must be a proficient typist (at least 30 WPM) with the ability to maneuver through various computer platforms/screens while verifying a variety of information simultaneously.
  • Ability to multi-task while staying organized.
  • Customer Service experience in a 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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