Hours

Full-Time: 80 Hours/Biweekly

8:30am - 5:00pm

General Summary

Explains benefit coverage, answers members' questions and inquiries, and documents appropriately. Uses exceptional customer service practices. Represents Quest in a professional and positive manner. Requires an intermediate degree of technical and communications/interpersonal skills, knowledge, and ability. May participate in programs, projects, and/or processes as assigned. Works collaboratively with care management, claims and provider relations staff for the good of Quest members and providers.

Duties and Responsibilities

Essential Functions:

Answers and manages a high volume of fast paced incoming telephone calls. Places outbound calls as needed. Provides exceptional customer service at all times by identifying and addressing member needs in a professional, positive, and caring manner. Enters and maintains detailed information in confidential member records. Manages work queues within the electronic health record (Epic). Manages and completes registrations for MyQuestBH and addresses inbox messages received. Understands and demonstrates knowledge of insurance and enters information appropriately into the electronic health record. Explains benefit coverage and/or claim status to members and/or providers through verbal or written communications. Interacts with appropriate sources to answer members' questions/inquiries and resolves member concerns and problems appropriately through verbal or written communications. Collaborates with care management staff based on individual situations to address member needs. Works closely with claims and provider relations teams to address member and/or provider inquiries and concerns. Opens and routes incoming mail; distributes correspondence and other material to staff. Prepares outgoing mail, appropriately following policies and procedures. Contacts provider offices or other departments when necessary to obtain additional information on behalf of the member. Assists members by offering in-network provider information and/or securing appointments as appropriate. In close collaboration with care management, participates in a variety of departmental teams focused on supervisory referrals and autism services. Supports providers in utilizing Tapestry Link for claim submission. Assists members with navigation and questions related to the Quest website. Uses appropriate resources available to provide general information to members. Serves as a resource to their team and answers any questions, as well as uses critical thinking to resolve issues and concerns real-time. Under direction of the Supervisor, assists in training new staff when assigned and provides ongoing support and instruction when they become independent. Communicates new hire's progress and performance with Supervisor. Works various reports as assigned and makes proactive recommendations in updating department resources and reference materials. May assist in process improvement initiatives as identified. Assists leadership as requested and handles sensitive/difficult situations appropriately. Consistently displays good judgement, decision-making and independence, and can effectively function with limited guidance and supervision. Participates in answering questions from staff using internal messaging and follows up when necessary. Promotes active engagement of all employees and supports recognition of staff accomplishments.

Common Expectations:

Adheres to established policies and procedures, objectives, quality assessment, and safety standards. Maintains professional growth and development. Maintains appropriate records, reports, and files as required for the department. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. Participates in educational programs and staff meetings required for the department. Greets and directs visitors when needed.

Qualifications

Minimum Education:

High School Diploma or GED Required Associates Degree Preferred or Bachelors Degree Preferred

Work Experience:

2 years Relevant experience. Required Customer service experience. Preferred

Courses and Training:

Complete Medical Terminology course. within 1 year Required

Knowledge, Skills, and Abilities:

Excellent communication and interpersonal skills. Basic computer skills with knowledge of Microsoft Office suite. You’re unique and you belong here.

At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email at . We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.