Clinical Services Representative

Job Title

Responsible for communication between all customers via telephone. Customers include employees, members, physicians, referral sources, and providers. The communication includes, benefit coverage, medical services, appeals and grievances, provider access and availability, claims investigation. The position utilizes computer terminal to manage and obtain essential information. Research inquiries and demonstrates a strong ability to resolve issues according to the Plan document and policies and procedures.

Refers unsolved inquiries and corrections to the appropriate analyst for resolution. Achieves maximum time effectiveness and customer service by answering all incoming phone calls within 3 rings. Provides clerical and telephone support for Case Management program. Maintains provider file compliance according to directive. Performs duties as assigned by Supervisor within the scope of knowledge and skill

• Previous computer experience preferred
• Good communication and customer services skills.
• Experience with LOS client support services, Epic, Sunquest, LIS and COPIA System user activity.
• Pleasant and professional attitude, including well developed interpersonal skills.
• Ability to make progress on multiple assignments under time constraints.

• High school graduate or GED.

USD $23.00

USD $37.00