Summary of Responsibilities:
Answers inquiries primarily through telephone communications with a high level of quality customer service. Prepares pre-notification documentation for medical procedures and various prescription drugs. Maintains benefit eligibility information for associates and retirees in multiple systems. Handles all responsibilities in accordance with the Plan provisions, department policies and various Department of Labor regulations. Works with minimal supervision and is responsible for making an established range of decisions, escalating to Manager when necessary and updating Manager on a regular basis.
Answers associate and health care providers’ requests over the telephone or through written correspondence within the time service standards set by the department. Exercises excellent customer service skills ensuring each contact is a positive experience by using a professional tone, displaying empathy as appropriate, being sincere and practicing good listening skills. Uses sound judgment when confronted with an unusual or unfamiliar request.
Administers the Open Enrollment process involving communication with all Home Office and Field associates as well as all retirees to maintain or change their benefits for the upcoming plan year.
Obtains medical information from associates, hospitals and doctors for pre-existing, outpatient/inpatient preauthorization reviews, second opinion determinations and concurrent reviews for inpatient admissions. Creates and updates nurse record screen on the benefits claim system including all medical information obtained from the member, hospital and physician offices. This information is vital in the nurses' daily monitoring of the patient's continued care.
Creates and maintains benefit information for each associate, retiree and eligible family members in multiple systems used in the Benefits Department. Records must be updated timely and accurately to ensure payroll deductions are correct and medical/dental claims are processed correctly.
Administers the prescription drug program. Maintains override information on all preauthorized prescriptions.
Maintains compliance with applicable federal and state laws (e.g., HIPAA) related to privacy, security, confidentiality, and protection of personal information, including, but not limited to, personal health information and personally identifiable information.
Performs other duties as assigned by management.
Demonstrated experience maintaining a calm and professional demeanor when handling difficult and sensitive situations with callers.
Proven success working in a high-volume call center as a service rep identifying customer issues, defining and resolving problems, and collecting or interpreting data to establish facts, draw valid conclusions and provide effective resolutions.
Demonstrated excellent verbal and written communication skills with ability to convey information, verbally and in writing, to internal and external customers at all levels in a clear, accurate, focused and concise manner. Demonstrated ability to document procedures and activities in a manner that is understandable to others and prepared using a prescribed format. Verbal and written communications are to conform to proper rules of punctuation, grammar, diction and style.
Demonstrated experience working as part of a team developing cooperation and collaborative work efforts toward solutions that benefit all parties involved.
Proven experience completing multiple assignments simultaneously, and completing assigned tasks accurately and on a timely basis. Must demonstrate strong attention to detail with excellent organizational skills.
Proven ability to handle confidential information in a discreet manner.
Works in an office setting and remains continuously in a stationary position for long periods of time while working at a desk, on a computer or with other standard office equipment, or while in meetings.
Performs continuous keyboarding work requiring the ability to make repetitive motions of the wrists, hands and/or fingers.
Requires visual acuity to read a variety of correspondence, reports and forms and to prepare and analyze data in an accurate, neat and thorough manner.
Computer Skills and Knowledge of Hardware & Software Required:
Certifications & Licenses (i.e., Series 6 & 63, CPA, etc.):
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