Customer Resolution Associate - R00000048401 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 ServiceWork Experience - Preferred Education - RequiredGED, High School Education - PreferredBachelors License and Certifications - RequiredLicense 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
