Job Description

Position Purpose: The Contact Center Buddy is a single point of contact for members for all things related to the health plan. A Contact center Buddy assists members in navigating the health plan and executes activities such as (but are not limited to); find quality doctors, schedule appointments, communicate with internal and external partners (case managers, providers, claims etc.), resolve member issues.

  • Provide inbound and outbound communication and develop a relationship with members
  • Assist with wellness campaigns to ensure successful outcomes
  • Educate members on wellness programs to better manage a health condition or disease
  • Conduct member interactions through multiple channels such as telephone, email, mail
  • Complete any necessary paperwork and facilitate the processing of prior authorization requests, case management referrals, bill problems, pharmacy issues etc.
  • Obtain all medical information needed for determination and forward to clinical reviewers when criteria is not met
  • Coordinate authorizations after the initial 7-day authorization has expired
  • Complete outbound member retention calls

Education:

  • High School Diploma or equivalent GED
  • Associates degree or higher preferred

Years of Experience:

  • At least two (2) years customer service preferred
  • At least 1 year Health plan experience preferred
  • Previous Medicaid/Medicare experience preferred

Specialized Knowledge:

  • Knowledge of Microsoft office; Word, Excel
  • Knowledge of Medicare and Medicaid regulations and guidelines preferred
  • Effective time management skills
  • Strong ability to logically resolve issues and interpret findings
  • Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
  • Work cooperatively, positively, and collaboratively in an interdisciplinary team

Application Instructions

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