Customer Resolution Associate - R00000050305 DESCRIPTION/RESPONSIBILITIES:This position is responsible for providing assistance with the resolution of authorization and/or claim issues in various work queues resulting from and calls taken from facilities and providers. Acts as liaison between providers, internal departments and specific accounts, clients, and claims department.* Resolves cases in queue due to member eligibility issues, referring provider verification or request, imaging provider verification, redirection, and retro reviews.* Assists with authorization problem resolution through research and facilitating the resolution of the problem in a timely fashion.* Process, forward, trend, and maintain records of authorization issues.* Acts as a troubleshooter to resolve problems among internal departments.* Handles special requests from Customers requiring manual workarounds or specials projects.* Investigates written/verbal complaints involving authorizations, and resolves complex issues with Customers and Providers.* Assists specific accounts who have special processes.* Observes and tracks authorization problem trends and works with internal department for resolution.* Assists with User Acceptance Testing (UAT).* Provides phone back-up coverage for other teams as needed. Other Job RequirementsResponsibilitiesAbility to review and interpret multiple contract/account information to successfully resolve issues regarding benefit plan administration; experience with account benefit structures.Demonstrated ability for problem solving, meeting deadlines, initiative and follow-through.Excellent written and verbal communication skills.Knowledge of pharmacy benefits management.Understanding of customer service performance metrics (ASA, abandonment rate, talk time). General Job InformationTitleCustomer Resolution Associate Grade18 Work Experience - RequiredClaims, Customer Service Work Experience - Preferred Education - RequiredGED, High School Education - PreferredBachelors License and Certifications - Required License and Certifications - Preferred Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures. Equal Opportunity Employer-minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
