Assist members who need to transition their care (medical or pharmacy) to Kaiser Foundation Health Plan of Washington in partnership with Pre-Service, Pharmacy, and other areas as needed.Document each phone call in the electronic medical record, update case notes and, data in multiple data management systems.Assist members with selecting their primary care provider. Schedule the first appointment for new members. Respond to complex situations escalated by Customer Service, Sales, Employer Groups, or Brokers.Assist members registering for the Kaiser Permanente website and provide web support.Coordinate interpreter services when needed.Answer questions regarding members' benefits, claims, contracts, coverage, billing, and premium payments.Adhere to strict HIPAA regulations and guidelines.

Adjudicate preauthorization requests based on members' coverage, benefits, clinical criteria, andmedical necessity. Refer requests requiring clinical judgment to the Prior Authorization Clinical Review Clinician, Manager, or Medical Director. Knowledge of health plan benefits and policies.Medical coding CPT / ICD-10. Receive and process incoming calls from members, external providers, and internal Kaiser Permanente departments.Perform and research complex issues related to authorization denials, delays, and claim-related issuesAbility to find the root cause of an issue, emphasizing problem-solving and conflict resolution.Provide an accurate, concise explanation to the member, provider, and internal Kaiser Foundation Health Plan of Washington departments.