The representative handles inbound calls from members and medical providers to address inquiries regarding benefits, eligibility, and appeals. They are responsible for updating customer files, resolving issues, and collaborating with team members to ensure high-quality service.
The Utilization Management Nurse performs medical necessity and benefit reviews using evidence-based guidelines and clinical criteria. They collaborate with healthcare partners and present cases to the Medical Director to ensure timely and compliant care determinations.
The Account Executive manages day-to-day client relationships for self-funded employer groups, ensuring high satisfaction, retention, and renewal. They act as an internal advocate, coordinating with cross-functional teams to deliver seamless service and strategic insights.
The Eligibility Service Representative will manage caregiver inquiries and resolve issues related to eligibility, benefits, and premium billing. They will also perform call center functions and collaborate with internal teams to ensure timely and accurate resolution of customer requests.
The Eligibility Service Representative will manage caregiver inquiries and resolve eligibility, hours, or premium issues through various communication channels. They are responsible for conducting research, maintaining client requirements, and collaborating with internal teams to ensure high-quality service delivery.
The Eligibility Service Representative will manage caregiver inquiries and resolve issues related to eligibility, benefits, and premium billing. They will also conduct outreach to internal partners and maintain accurate records while ensuring high-quality customer service across multiple communication channels.
The Eligibility Service Representative is responsible for resolving caregiver inquiries regarding eligibility, benefits, and enrollment issues. They will manage requests through multiple channels while ensuring high-quality service and timely resolution of complex problems.
The role involves developing KPIs, statistical models, and predictive analytics to monitor clinical program performance and member outcomes. The analyst will create client-facing dashboards and provide actionable insights to inform healthcare strategy and ROI.
