Job Description
Location: NC-Durham
Operations Specialist
Durham, North Carolina
100% Remote
Contract
$18/hr – $20/hr
Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Operations Specialist. They have over 4 million customers and 5,000+ employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs.
While the position is Remote, you must reside in North Carolina or one of the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
Contract Duration: 12 + Months
Required Skills & Experience
- High School diploma or GED with 3 years customer service and/or call center experience
- Experience working in a healthcare or health insurance environment with some working knowledge of insurance and medical terminology
- The ability to identify and analyze situations and provide recommendations for improvement.
- Ability to effectively prioritize and manage time Proficient in a Windows Operating Environment
Desired Skills & Experience
- Knowledge of our clients policies, processes and standard operating procedures preferred
- Resource will receive Care Navigation referrals from CareRadius and experience with CareRadius is a plus, but not required. CareRadius is the system of documentation
What You Will Be Doing
Daily Responsibilities
- Not a high call volume, there will be 6 team members and the calls are on rotation within the team que so the resource may receive 1 to 2 calls a day depending on volume.
- Most cases are received as internal referrals.
- This role is for mainly for Mental Health support and the resource will be assisting with finding a provider within the network and scheduling an appointment and then following up after the appointment as well.
- Receive Behavioral Health referral requests and inquiries from various sources including members, providers, and internal staff; accurately process via phone, email, fax, and mail for all lines of business.
- Receive referrals from Utilization Management (UM) to assist with finding appropriate inpatient, residential, or other types of care for members who receive a denial or other facility requests from UM
- Make outbound calls to various providers, members, or other outside contacts as part of the referral fulfillment process
- Provide education and guide members to ensure they are informed of the lifecycle of the referral process (e.g., actions to schedule appointments; outreach from the provider who received the referral and follow-up calls from the Care Navigator).
- Utilize expertise in referral process to assist UM, Customer Service, and Case Managers with member and provider referrals.
- Document all pertinent information related to the call/inquiry, attach supporting information as applicable, and if unable to resolve route to the appropriate area for follow-up.
- Identify and document escalated, recurring or complex system and process problems. Recommend alternatives and solutions; interface with project teams to resolve these complex issues.
- Develop and maintain assigned reports on a daily, or as required basis.