JOB DESCRIPTION, MAIN DUTIES, AND RESPONSIBILITIES:● Responding to inbound emails (inquiries, requests for records)● Utilization of different CRM/EMR/EHR system● Inbound phone calls to assist clients, patients, and third-party inquiries and follow-up ● Outbound phone calls: Proactively contact external resources as needed to address caller questions/issues (e.g., provider office, provider relations, network management)● Appointment scheduling● Medication assistance – pharmacy location● Verification of benefits and eligibility● Demonstrate knowledge of applicable products/services (e.g., benefit plans, Medicare, Medicaid, In-network, Out-of-network)● Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, BAA, state/regional requirements)● Demonstrate understanding of internal/external factors that may drive client and third-party entities' questions/issues (e.g., recent plan changes, mass mailings, call directing/rerouting, weather emergencies)● Writing and maintaining records

JOB DESCRIPTION, MAIN DUTIES, AND RESPONSIBILITIES:● Provide quality metric analysis on compliance scores, CSAT/Customer Satisfaction, first call resolution, and other agent quality performance measures● Provide root cause analysis on program, team, and agent-level identified opportunities● Provide recommended intervention activities to address quality metric opportunities identified● Provide training agenda feedback on nesting quality metric performance● Provide analysis on other operational metrics such as average handle time, emails per hour, etc.● Monitor the QA Scores of the assigned account● Track and act on customer feedback● Review Quality parameters and make changes whenever necessary in consultation with Operations● Monitor Calibration levels● Prepare Quality Improvement Plans

JOB DESCRIPTION, MAIN DUTIES, AND RESPONSIBILITIES:● Supply individuals with details about the extent of members' health insurance coverage, eligibility, and benefits● Provide hands-on customer service, including customer transactions, prior authorizations, denials and appeals, and case inquiries● Responsible for the medical claims adjudication process

JOB DESCRIPTION, MAIN DUTIES, AND RESPONSIBILITIES:● Answering inbound phone calls, addressing customers’ questions about products and services, and processing payments or returns● Handle customer complaints, provide appropriate solutions and alternatives within the time limits; follow up to ensure resolution● Assist customers in settling technical problems associated with the product or service