Customer Service Liaison

hace 2 meses


San Juan, San Juan, Puerto Rico The Midtown Group A tiempo completo

Job Summary: We are seeking a highly motivated and experienced Customer Service Representative to join our team at The Midtown Group. The selected candidate will be responsible for providing exceptional customer service to members and providers, addressing inquiries, and ensuring seamless communication throughout the OneCare program.

Responsibilities:

  1. Participate in a mission-driven culture of high-quality performance, focusing on customer service, consistency, and dignity.
  2. Assist the team in carrying out department responsibilities and collaborate with others to support short and long-term goals and priorities.
  3. Guide members in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal through the OneCare program.
  4. Address member and provider inquiries, questions, and concerns in all areas, including eligibility, enrollment, claims, or authorization status, benefit interpretation, and referrals/authorizations for medical care.
  5. Enter accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.
  6. Initiate referrals to both internal and external care management departments and other departments, governments, or community agencies.
  7. Participate in departmental phone outreach campaigns on a regular basis.
  8. Complete other projects and duties as assigned.

Requirements:

  • High school diploma or equivalent required.
  • 6 months of experience in a call center capacity required.
  • Bilingual in English and one of the defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required.

Preferred Qualifications:

  • 6 months of health maintenance organization (HMO), Medi-Cal/Medicaid, and health services experience.
  • Typing speed of 35 words per minute (WPM).


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