Opportunity Description
Healthcare Expert
Responsibilities
- Handle inbound and outbound calls related to healthcare services, insurance benefits, claims, and eligibility verification.
- Assist members, providers, and patients with inquiries regarding coverage, billing concerns, authorizations, and account status.
- Accurately document all interactions in the system while adhering to HIPAA and company compliance standards.
- Review and verify patient/member information to ensure data accuracy and confidentiality.
- Coordinate with internal departments (claims, billing, pharmacy, prior authorization teams) to resolve concerns efficiently.
- Explain healthcare policies, procedures, and benefits clearly to customers in a professional manner.
- Escalate complex or urgent cases to the appropriate team when necessary.
- Meet or exceed key performance indicators (KPIs) such as AHT, CSAT, quality scores, and first call resolution. <...
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