Job Title: Specialist

Job Description

The Specialist is responsible for answering incoming inquiries from health plan members, employers, providers, and health plans. This role involves assessing the purpose of inquiries and providing appropriate information, ensuring compliance with relevant regulatory agencies to maintain plan licensing.

Responsibilities

• Handle inquiries from members, employers, providers, and health plan coordinators.
• Assess patient needs and route them to the appropriate department or party.
• Project a professional and helpful demeanor to all patients.
• Remain calm when handling difficult or upset patients.
• Consistently provide accurate and thorough information to patients.
• Use available resources to research and resolve moderately complex issues.

Essential Skills

• Care management
• Managed care
• Healthcare industry
• Health administration
• Troubleshooting
• Medical terminology
• Case management
• Health care
• Customer service
• Data entry

Additional Skills & Qualifications

• One or more years working in a healthcare or related business environment performing general office duties.
• Experience working in a managed care environment preferred.
• High school diploma or GED required.
• Successful completion of a vocational/technical/business program in a related field of study, such as Medical Assistant or Medical Office Assistant, may be considered in lieu of work experience.

Work Environment

This position operates Monday to Friday from 8am to 5pm, with a one-hour lunch break. Remote work is available, and early morning shifts may be necessary if approved by the director due to high queues.