Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.
Communicates, builds and maintains internal and external relationships by prompt and accurate service.
Identifies and communicates challenges that might arise with the use of professional judgement while adhering to departmental policies and procedures.
Follows through on and completes all member and provider inquiries or requests.
Enters accurate, complete and correct documentation into Facets regarding all issues and/or inquires, complaints and grievances. Serves as a resource for other team members.
