Call Center Specialist

Job Description:
Under the direct supervision of the Supervisor-Call Center and general supervision of the Director of Operations , provides diversified, collaborative, and confidential administrative support to care management, claims and provider relations staff. Explains benefit coverage, answers members' questions and inquiries, and documents appropriately regarding interactions with members and providers. Requires an intermediate degree of technical and communication skills, knowledge, and ability, as well as excellent interpersonal skills and customer service practices. May administer/ coordinate programs, projects, and/or processes as assigned.
Duties and Responsibilities

1. Answers and manages a high volume of fast paced incoming telephone calls. Places outbound calls as needed. Provides exceptional customer service at all times by identifying and addressing member needs in a professional, positive, and caring manner.
2. Enters and maintains detailed information in confidential member records.
3. Manages work queues within the electronic health record (Epic).
4. Manages and completes registrations for MyQuestBH and addresses inbox messages received.
5. Understands and demonstrates knowledge of insurance and enters information appropriately into the electronic health record.
6. Explains benefit coverage and/or claim status to members and/or providers through verbal or written communications.
7. Interacts with appropriate sources to answer members' questions/inquiries and resolves member concerns and problems appropriately through verbal or written communications.
8. Collaborates with care management staff based on individual situations to address member needs. Works closely with claims and provider relations teams to address member and/or provider inquiries and concerns.
9. Compiles data for and prepares regularly scheduled or special reports, analyses, and statements. This may include assisting with report materials and meeting preparation for Quest's Board of Directors or owner groups
10. Opens and routes incoming mail; distributes correspondence and other material to staff. Prepares outgoing mail, appropriately following policies and procedures.
11. Contacts provider offices or other departments when necessary to obtain additional information on behalf of the member.
12. Assists members by offering in-network provider information and/or securing appointments as appropriate. Follows up with members within three days of offering provider information for confirmation of appointment; offers to assist in securing an appointment when appropriate.
13. In close collaboration with care management, participates in a variety of departmental teams.
14. Supports providers in utilizing Tapestry Link for claim submission.
15. Assists members with navigation and questions related to the Quest website and MyQuestBH member portal.
16. Serves as a resource to their team and answers any questions, as well as uses critical thinking to resolve issues and concerns real-time.
17. Under direction of the Supervisor, assists in training new staff when assigned and provides ongoing support and instruction when they become independent. Communicates new hire's progress and performance with Supervisor.
18. Works various reports as assigned and makes proactive recommendations in updating department resources and reference materials. May assist in process improvement initiatives as identified.
19. Consistently displays good judgement, decision-making and independence, and can effectively function with limited guidance and supervision.
20. Participates in weekly self-evaluation of calls and reviews results of both self-evaluations and supervisor audits monthly.
21. Promotes active engagement of all employees and supports recognition of staff accomplishments.
22. Administers/coordinates programs, projects, and/or processes as assigned.

Qualifications

• Minimum Experience:
  • 3-4 years
  • Min Field of ExpertiseBusiness or Healthcare Administration; Customer Service experience preferred
• Minimum Education:
  • Associate's Degree
• Minimum Field Of Expertise:
  • Customer Service preferred, but not required
• Preferred Education:
  • Bachelor's Degree
• Skills:
  • Basic computer skills with knowledge of Microsoft Office suite; excellent interpersonal/communications skills;
  • Completes Medical Terminology course within one year of date of hire.