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Member Services Specialist Senior
DescriptionSummary:The Customer Service Representative (CSR) answers all incoming calls from sponsors, members, and providers. Researches claim status, and assists in bringing resolution to the claim problem by thorough analysis. To do this, the CSR must have a thorough understanding of the claims process to ensure repeat calls do not occur due to unclear or inaccurate information. Outbound calls are made by the CSR to close the communication loop with the caller as required and the CSR must manage this process to coincide with lulls in call center inbound call volumes. The CSR must also have a solid understanding of the appeals and grievances processes, enrollment and eligibility, behavioral health and whether or not an authorization is require
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