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. We do not lose sight of that. 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 include :

• 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.
• Assists in the mentoring and training of new staff.
• Assumes full responsibility for self-development and career progression.
• 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.
• Educates providers on how to submit claims and when / where to submit a treatment plan.
• Identifies and responds to Crisis calls.
• Informs providers and members on appeal process.
• Leads or participates in activities that help improve Care Center performance.
• Links or makes routine referrals and triage decisions.
• Performs necessary follow-up tasks.
• Provides information regarding in-network and out-of-network reimbursement rates.
• Refers callers requesting provider information to Provider Services.
• Refers patients / EAP clients to the Care Management team.
• Updates self on ever changing information.
• Supports team members and participates in team activities.
• Documents customers comments / information.

Minimum Qualifications :

Additional Qualifications :

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.