This position is a frontline service position communicating to Clients members and providers programs, policies, and procedures. Responsibilities include answering incoming calls on eligibility, benefits, claims, and authorization of Services from providers and members. Responsibilities also include the administration of intake documentation in the appropriate systems. Overall, the Customer Service Associate is expected to provide outstanding service to our internal and external customers and strive to resolve member and provider needs on the first call. The CSA provides outstanding service while also achieving operating performance rating of meets or exceeds call center production standards.
- Actively 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 claims resolutions and other expressions of dissatisfaction. Refers patients/EAP clients to the Clients Care Management team for a provider, EAP affiliate, or Facility.. Refers callers requesting provider information to Provider Services regarding Clients professional provider selection criteria and application process. Links or makes routine referrals and triage decisions not requiring clinical judgment. Provides information regarding Clients in-network and out of network reimbursement rates and states multiple networks to providers. Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved. Informs providers and members on Clients appeal process. Educates providers on how to submit claims and when/where to submit a treatment plan.
- Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. Thoroughly documents customers comments/information and forwards required information to the appropriate staff. Performs necessary follow-up tasks to ensure member or providers needs are completely met.
- Lead or participate in Care Management Center activities as requested that help improve Care Center performance, excellence and culture. Support team members and participate in team activities to help build a high-performance team. Demonstrate flexibility in areas such as job duties and schedule in order to aid Care Management Center in better serving its members and help Client achieve its business and operational goals. Assist CMC efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
- Assume full responsibility for self-development and career progression. Proactively seek and participate in ongoing training (formal and informal) in all aspects of the Customer Service Associate role. Assist in the mentoring and training of new CSAs. Remain responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
Astyra Corporation is an staffing and consulting company that is locally owned and operated right here in the heart of RVA. Astyra offers a unique approach to solving the business challenges of its clients. After being in business for over 20 years we have evolved and grown - smart ideas, ingenuity and never settling for failure are our hallmark traits. We are locals with a national presence and need a like-minded; client focused professional who wants to make a difference every day.
Location/Region: Richmond, VA (US)