Customer Service Associate II

This position is a front-line service position providing assistance to Magellan’s members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims status, EAP services, crisis calls and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards.

• Listens and probes callers in a professionally and timely manner to determine purpose of the calls.
• Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claims status, crisis calls, and authorization inquiries to callers while maintaining confidentiality.
• Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.
• Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assists in the mentoring and training of new staff.
• Assumes full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).
• Assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.
• Demonstrates flexibility in areas such as job duties and schedule to aid in better serving members and help Magellan achieve its business and operational goals.
• Educates providers on how to submit claims and when/where to submit a treatment plan.
• Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.
• Informs providers and members on Magellan’s appeal process.
• Leads or participates in activities as requested that help improve Care Center performance, excellence and culture.
• Links or makes routine referrals and triage decisions not requiring clinical judgment.
• Performs necessary follow-up tasks to ensure member or provider's needs are completely met.
• Provides information regarding Magellan’s in-network and out-of-network reimbursement rates and states multiple networks to providers.
• Refers callers requesting provider information to Provider Services regarding Magellan's professional provider selection criteria and application process.
• Refers patients/EAP clients to the Magellan’s Care Management team for a provider, EAP affiliate, or Facility.
• Updates self on ever changing information to ensure accuracy when dealing with members and providers.
• Supports Customer Care Associate I and new hires and participates in team activities to help build a high-performance team.
• Documents customers comments/information and forwards required information to the appropriate staff.
• Assists occasionally with User Acceptance Testing (UAT) plans as new systems and/or applications are rolled out or upgraded.

Other Job Requirements

Responsibilities

PREFERRED QUALIFICATIONS: (Additional skills necessary to exceed minimum performance standards)

1. Education: College degree

2. Experience: Experience in a Customer Service/Health Care environment

General Job Information

Title

Customer Service Associate II

Grade

17

Work Experience

Customer Service

Education

GED (Required), High School (Required)

License and Certifications - Required

License and Certifications - Preferred

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.