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Customer Care Associate
Ref No.: 18-06703
Location: Orlando, Florida
Job Title: Customer Care Associate
Job Location: Orlando, FL
Job Duration: 3 + Months Contract


Job Description:
  • This position is a frontline service position providing assistance to Client's members and providers regarding programs, policies, and procedures.
  • Responsibilities include answering incoming calls related to 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.

Must be registered with FL State Board of Pharmacy​

Essential Functions:
  • Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.
  • 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.
  • Assist in the mentoring and training of new staff. - Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
  • Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
  • Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help Client achieve its business and operational goals.
  • Educates providers on 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 Client''s appeal process. - Lead or participate 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 Client's in-network and out-of-network reimbursement rates and states multiple networks to providers.
  • Refers callers requesting provider information to Provider Services regarding Client's professional provider selection criteria and application process.
  • Refers patients/EAP clients to the Client''s Care Management team for a provider, EAP affiliate, or Facility.
  • Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
  • Support team members and participate in team activities to help build a high-performance team.
  • Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.
Requirements/Certifications:
  • Responsibilities DO NOT include: claims, eligibility, benefits, or prior authorizationsMust 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.
  • Must be flexible in scheduling and comfortable with change - 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.