100 % Remote
High volume healthcare call center experience needed
6 month contract with possibility to extend
8-5 M-F EST Hours
Process a variety of requests, inquiries and transactions via phone, email, fax, and mail
Review requests to ensure accuracy
Support internal & external customers via phone or email
Document all pertinent information related to the call/inquiry, attach supporting information as applicable and if unable to resolve route to appropriate area for follow up as applicable
Gather and analyze data to provide feedback to Team Leads on employee development needs and/or specific providers requiring education on prior approval or pre-certification process
Screen inquiries to determine if authorization is required
Verify member benefits and eligibility and/or provider setup.
Maintain and update Service Requests and research incorrect or missing information.
Triage and assign all incoming inquiries in a timely, efficient manner throughout the day to appropriate staff
Perform Peer Audits monthly as required
Provide clinical review outcome notification to members and providers (verbal and written)