Care Coordinator

Company: Prime Care Benefits Group
Position: Care Coordinator
Location: Remote (Occasional Onsite Attendance Required)
Employment Type: Full-Time
FLSA Classification: Non-Exempt (Hourly)
Union Status: Union-Represented Position
Reports To: Lead Care Coordinator

Prime Care Benefits Group is seeking a dependable, detail-oriented, and customer-focused Care Coordinator to join our team!

In this role, you will serve as a primary point of contact for members and healthcare providers, assisting with dental and vision benefit inquiries, eligibility verification, referrals, and authorization requests.

The ideal candidate is an excellent communicator who enjoys helping others, thrives in a fast-paced environment, and can manage multiple responsibilities while maintaining accuracy and professionalism.

This is a remote position with occasional required onsite attendance for meetings, training, and other business needs.

Member & Provider Support

• Answer incoming calls from members, providers, and office staff regarding dental and vision benefit plans.
• Assist callers with eligibility verification, benefit coverage, referral status, authorization status, and general plan questions.
• Provide friendly, professional, and accurate customer service.
• Research and resolve inquiries efficiently, escalating complex matters when necessary.
• Maintain thorough and accurate documentation of all interactions.

Referral & Authorization Processing

• Accurately review, enter, and process dental and vision referrals and authorization requests.
• Ensure all referrals and authorizations are processed within 48 hours of receipt.
• Review submitted information for completeness and accuracy.
• Coordinate with internal departments to resolve eligibility, claims, and authorization concerns.
• Follow established procedures to ensure timely processing and compliance.

Quality & Performance

• Meet established productivity, accuracy, and customer service standards.
• Support call center performance goals, including an abandonment rate below 3% and an average speed to answer of less than 30 seconds.
• Maintain professional communication with members, providers, and colleagues.
• Protect confidential member information and comply with HIPAA requirements.
• Participate in team meetings, training sessions, and ongoing professional development.

Required:

• High school diploma or equivalent.
• Strong verbal and written communication skills.
• Excellent customer service and problem-solving abilities.
• Strong organizational skills and attention to detail.
• Ability to multitask and navigate multiple computer systems simultaneously.
• Proficiency in Microsoft Office and general computer applications.
• Ability to work independently, manage time effectively, and meet performance expectations in a remote environment.
• Reliable internet connection and a quiet, professional workspace.

Preferred:

• 1–2 years of customer service or call center experience.
• Experience in dental, vision, health insurance, or managed care.
• Familiarity with insurance eligibility verification, referrals, and prior authorizations.
• Previous experience working in a high-volume call center.
• Bilingual communication skills.

• Remote work environment.
• Occasional mandatory onsite attendance for meetings, training, or operational needs.
• Frequent telephone communication and computer use throughout the workday.
• Ability to remain seated and work at a computer for extended periods.
• Must maintain a professional, distraction-free workspace suitable for handling confidential information.

We're looking for someone who is:

• Customer-focused: Passionate about helping members and providers navigate their benefits.
• Detail-oriented: Committed to…