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 Requirements
Responsibilities
Ability 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 Information
Title
Customer Resolution Associate
Grade
18
Work Experience - Required
Claims, Customer Service
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
Bachelors
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.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .
Warning: Employment Scam
It has come to our attention that a false representative is contacting potential candidates and offering them work at home positions with Magellan Health. -Interviews- are conducted completely through email and the false job offer includes the promise of a check to be issued to the candidate for the purposes of setting up a home office.
Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911
