Call Center Representative

Job Summary and Responsibilities

Acentra Health is looking for a Call Center Representative to join our growing team. 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.

• Meet or exceed operations production and quality standards.
• Accurately respond to inbound phone calls and processing provider and member inquiries and requests into the appropriate system and database.
• Resolve customers’ service or billing complaints by demonstrating sound judgement.
• Contact customers to respond to complex inquiries or to notify them of claim investigation results and any planned adjustments.
• Resolve customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation.
• Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
• Actively listen and probe callers in a professional and timely manner to determine purpose of the calls.
• Research and articulate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
• Educate providers on how to submit claims and when/where to submit a treatment plan.
• Perform necessary follow-up tasks to ensure member or provider needs are completely met.
• Support team members and participate in team activities to help build a high-performance team.
• Thoroughly document customers' comments/information and forward required information to the appropriate staff.
• Escalate calls to Call Center Lead when necessary.

Qualifications

• High School graduate or GED.
• At least 1 year of customer service-related experience.
• Previous experience with computer applications, such as Microsoft Word and PowerPoint.
• 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 flexible in scheduling and comfortable with change as customer service is an ever-changing environment.

Preferred Qualifications

• Bilingual Spanish speaking.
• Call center experience.
• Healthcare industry experience.
• Medicaid experience.