Contact Center Agent
Reports to: Department Manager
Department: Global Health Services
Calibrated Healthcare Network (CHN) manages over 11 million lives in over 8 states, partnering with industry leaders in the area of managed care. Our operating model features global workforce strategies, coupled with efficient technological solutions. We have a proven expertise in re-engineering complex managed care business processes to provide value to our esteemed partners. Our commitment to the evolution of healthcare is evident in our investment in research and development for the progression of dynamically enhanced technology to meet the needs of partners. The core suite of services includes Claims Adjudication, Benefits Setup, Member Enrollment and Eligibility Setup, Claims System Configuration, HCC Coding and MSO Development support.
The Calibrated Clinical Solution (CCS) global workplace is built on the concept of providing cost-effective care, enhancing population health strategies, and improving the quality of care. Calibrated Clinical Solutions deploys the use of proprietary software to create cost-effective workforce solutions constructed on the premise of collaboration technology. With our extensive domain of knowledge of managed care and dynamically enhanced technology, we have the capacity to create innovative solutions for our managed care and primary practice partners. Our core suite of services includes Medical Management, Utilization Management, Complex Case Management, and Population Health Management.
The Contact Center is an extension of provider offices or medical management operations either during office hours and/or after hours and weekends. The Contact Center agent is responsible for managing inbound and outbound call queues per departmental protocols.
- HS diploma required
- MA or other healthcare related Certification preferred
- 1-year managed care experience preferred
- Previous utilization management experience preferred
- Previous customer service experience preferred
- Core Competencies: Verbal Communication, Listening, Ethics and Values, Customer Focus, Action-Oriented, Attention to Detail, Priority Setting, Timely Decision-Making, Organizing, Functional and Technical Skills
- Computer Proficiency (General proficiency)
- High Level of Data Entry Accuracy
- Typing Skills (60 WPM preferred)
- Capacity to interpret health plan/client specific benefit guidelines, and policies/procedures
Essential Functions of Job
- Must be able to perform the functions of the UM Coordinator.
- Ensures compliance with outbound call protocols for referral specialty tracking, health risk assessments, or care gap closure outreach campaigns.
- Respond to telephone inquiries from patients, physicians, and other callers regarding appointments, referrals, provider messages, and services in accordance with established guidelines
- Maintains and improve quality assurance processes by adhering to quality and productivity standards and guidelines
- Responsible for researching information and using available resource to resolve caller concerns
- Appropriately identify, direct, or escalate clinical and priority caller concerns
- Complete call processing in an efficient manner; remain aware of call volumes; work as part of the team to handle the call volumes
- Responsible for ensuring customer interactions display characteristics of inquiry, empathy, courtesy, and respect
- Proactively read emails daily and keep up to date on all client protocols and communications
- Demonstrate consistent and punctual attendance
- Demonstrate behavior consistent with CHN mission, vision, and values
- Adheres to Desktop procedures and UM/CM policies and procedures
- Performs additional duties as assigned