Clinical Operations Representative

Responsibilities

• Responds to customer questions via telephone and written correspondence regarding medical cases.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Responsible for meeting or exceeding quality and productivity expectations to ensure customer satisfaction.
• Reviews and maintains service requests and call center database for completeness of information.
• Handles most complex calls with minimal assistance.
• Provides assistance in and/or refers high-level, complex questions, problems or client complaints to appropriate resources to ensure customer satisfaction.
• Enters updates to pertinent insurance data from Document Management System or FAX into the computer system in a timely manner ensuring accuracy, completeness, and adherence to department procedures.
• Performs outbound calls to members, providers, and clients.
• Respects and maintains HIPAA confidentiality guidelines.

Qualifications

• Minimum of 2 years’ experience in customer service, or healthcare operations.
• Associates Degree in a business or health related field is preferred.
• Demonstrates dependability by following instructions, policies, and procedures; exceeds productivity standards, meets deadlines, and adheres to work schedules.
• Strong problem solving and troubleshooting skills with precise attention to detail.
• Phone queue experience and data entry skills, preferred.
• Intermediate to advance proficiency in Microsoft Word, Excel and Outlook.
• Strong organizational skills and ability to multitask.

Benefits

• Competitive Compensation for full-time employees including, but not limited to: Medical, dental, vision, disability, life, Gym Discount, and PTO.
• All employees, age 21 and over, are eligible to participate in the 401(k)-retirement savings plan.