Customer Care Associate I - Remote - Healthcare Customer Service Representative - Patient Support and Experience

Join Our Team: Customer Care Associate I - Remote At Prime Therapeutics, we're dedicated to helping people get the medicine they need to feel better and live well. Our mission fuels our passion and drives every decision we make. We're seeking a highly skilled and compassionate Customer Care Associate I to join our team remotely. As a front-line service representative, you will provide exceptional support to our members and providers, addressing their concerns and resolving issues in a timely and professional manner. About Us Prime Therapeutics is a leading healthcare company that provides innovative solutions to help people navigate the complex healthcare landscape. Our fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's healthcare industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. Job Summary As a Customer Care Associate I, you will be responsible for providing outstanding service to internal and external customers, striving to resolve member and provider needs on the first call. You will actively listen and probe callers to determine the purpose of their calls, research and articulate information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries, while maintaining confidentiality. Key Responsibilities: Actively listen and probe callers in a professional and timely manner to determine the purpose of their calls. Research and articulate information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality. Resolve customer administrative concerns as the first line of contact, including claim resolutions and other expressions of dissatisfaction. Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies. Assist in the mentoring and training of new staff. Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal). Comprehensively assemble and enter patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help Magellan achieve its business and operational goals. Educate providers on how to submit claims and when/where to submit a treatment plan. Identify and respond to Crisis calls and continue assistance with the Clinician until the call has been resolved. Inform providers and members on Magellan's appeal process. Lead or participate in activities as requested that help improve Care Center performance, excellence and culture. Link or make routine referrals and triage decisions not requiring clinical judgment. Perform necessary follow-up tasks to ensure member or provider needs are completely met. Provide information regarding Magellan's in-network and out-of-network reimbursement rates and states multiple networks to providers. Refer callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process. Refer patients/EAP clients to the Magellan's 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 document customers' comments/information and forward required information to the appropriate staff. Requirements: Essential Qualifications: GED or High School Education required. Customer Service experience required. Proficient typist (avg. 35+ WPM) with strong written and verbal communication skills. Ability to maneuver through various computer platforms while verifying information on all calls. Ability to talk and type simultaneously. Flexibility in scheduling and comfort with change. Preferred Qualifications: Associates or Bachelor's degree. Previous experience in healthcare or a related field. What We Offer: Compensation and Benefits: We offer a competitive salary ranging from $16.00 - $21.26 per hour, based on experience and skills. Our pay range may vary by 8% depending on the applicant's location. In addition to our competitive salary, we offer a comprehensive benefits package, including: Medical, dental, and vision coverage. Retirement savings plan. Paid time off. Opportunities for professional growth and development. For more information on our benefits, incentives, and additional compensation, please visit our Benefits Page. Why Join Us: At Prime Therapeutics, we're committed to creating a work environment that is inclusive, diverse, and rewarding. We welcome people of different backgrounds, experiences, abilities, and perspectives. We're proud to be an equal opportunity and affirmative action employer, and we encourage diverse candidates to apply. As a Tobacco-Free Workplace employer, we're dedicated to providing a healthy and safe work environment for all our employees. How to Apply: If you're passionate about delivering exceptional customer service and making a difference in people's lives, we want to hear from you! Apply today to join our team as a Customer Care Associate I - Remote. Don't miss this opportunity to be part of a dynamic team that's shaping the future of healthcare. Contact us or visit our Careers Page to learn more about our current openings and to apply. We look forward to hearing from you and exploring how you can contribute to our mission! Apply for this job