Customer Service Care Associate (RPHT)
HAYS

The end client is unable to sponsor or transfer visas for this position; all parties authorized to work in the US without sponsorship are encouraged to apply.

A Managed Care Company is seeking a Customer Service Care Associate (RPHT) in Orlando, FL.

Role Description
• 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 claim resolutions and other expressions of dissatisfaction.
• Assists efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assists in the mentoring and training of new staff.
• Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
• Comprehensively 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 of 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 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.
• Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
• Support team members and participate in team activities to help build a high-performance team.
• Thoroughly documents customers' comments/information and forwards required information to the appropriate staff.

Skills & Requirements
• 2 years of customer service experience in a call center environment
• Mail Order Pharmacy experience
• Healthcare experience
• Microsoft office experience
• High School Diploma or GED
• RPHT License - strongly preferred

Why Hays?

You will be working with a professional recruiter who has intimate knowledge of the Information Technology industry and market trends . Your Hays recruiter will lead you through a thorough screening process in order to understand your skills, experience, needs, and drivers. You will also get support on resume writing, interview tips, and career planning, so when there's a position you really want, you're fully prepared to get it.

Additionally, this position is a contract role where Hays offers you the opportunity to enroll in full medical, dental or vision benefits.

• Medical
• Dental
• Vision
• 401K
• Life Insurance ($20,000 benefit)

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Hays is an Equal Opportunity Employer.

Drug testing may be required; please contact a recruiter for more information. #1114426