Customer Care Associate II

Customer Care Associate II

Our work matters. We help people get the medicine they need to feel better and live well. It fuels our passion and drives every decision we make. This position is a frontline service position providing assistance to members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations are 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.

Responsibilities

Listens and probes callers in a professionally and timely manner to determine purpose of the calls.

Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.

Resolves customer administrative concerns as the first line of contact this may include claim resolutions and other expressions of dissatisfaction.

Assists in the mentoring and training of new staff.

Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).

Assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.

Demonstrates flexibility in areas such as job duties and schedule in order to aid in better serving members and help achieve its business and operational goals.

Educates providers on how to submit claims and 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 the appeal process.

Leads or participates 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 in-network and out-of-network reimbursement rates and states multiple networks to providers.

Refers callers requesting provider information to Provider Services regarding professional provider selection criteria and application process.

Refers patients / EAP clients to the Care Management team for a provider, EAP affiliate, or Facility.

Updates self on ever changing information to ensure accuracy when dealing with members and providers.

Supports team members and participate in team activities to help build a high-performance team.

Documents customers comments / information and forwards required information to the appropriate staff.

Minimum Qualifications

HS Diploma or GED required

2 years of experience in Customer Service

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

Must be flexible in scheduling and comfortable with change as 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.

Must 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.

Preferred Qualifications

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship.

In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $19.23 - $28.85 based on experience and skills.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.