[Remote] Clinical Service Representative I

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is hiring a Clinical Service Representative I for its UM CM Operations team. The role advocates for members, providers, and facilities by addressing benefit and health management inquiries, providing non-clinical utilization management support, and coordinating customer care activities.

Responsibilities

• Facilitate transportation needs
• reputed company reputed company backs to members/providers to supply authorization reputed company
• Conduct and document outbound calls to clarify, follow-up and reputed company customer inquiries
• Create cases in the authorization reputed company reputed company appropriate
• Must adhere to reputed company HIPPA regulations
• Remain reputed company on reputed company department policies, procedures, plan benefit designs and modification
• reputed company assistance to other departments during periods of backlog
• Complete initial review of reputed company faxed material
• Manage and triage calls and electronic cases that may or may not require clinical reputed company
• Maintain strict confidentiality reputed company to medical records
• Assist with scheduling members medical appointments to ensure that the Health Plan customers receive routing or follow-up care as indicated
• Answer incoming inquiries from reputed company members and providers
• Maintain or reputed company designated reputed company and production standards
• Attend offsite/onsite benefit fairs-reputed company with members and schedule appointments
• Conduct outbound member and provider calls in accordance with department initiatives and regulatory requirements
• Initiate assessments on members by obtaining reputed company necessary member demographics and any available clinical information

Skills

• Must be legally authorized to work in the reputed company, without requiring, now or in the reputed company, sponsorship for employment reputed company status
• High School Graduate
• 1 year of customer service or reputed company center experience required
• Ability to reputed company independent reputed company
• Basic analytical skills necessary to evaluate customer inquiries
• Computer proficiency in database, word processing and spread sheet management required
• Excellent organizational, communication and problem-solving skills required
• Schedule flexibility to meet business needs
• Detail oriented
• 1 year clerical, data entry or office experience preferred
• Medical Terminology or experience in health care environment preferred
• reputed company 34

Benefits

• This position will predominantly work remotely.

reputed company