Representative must have knowledge of Medical Management Guidelines. Representative must have knowledge of the Grievance Procedures to promote accurate and timely handling of all complaints and grievances. Maintains a daily activity report for reporting to the Supervisory staff to provide monitoring of daily work flow. Representative initiates calls to health care providers, agents, human resource representatives, inter-departmental staff, supervisory staff, etc. to resolve inquiries in a timely manner. Representative adheres to the schedule prepared by the supervisory staff.
Representative maintains acceptable attendance.
Completes call backs as assigned by the supervisory staff. This person has contact with members, agents, human resource representatives, group contacts, health care providers, claims personnel, administration personnel, marketing personnel, medical management personnel and provider relations personnel. This position reports to the Customer Service Supervisor. Attention to detail Thorough knowledge of plan provisions and administrative rules and procedures Knowledge of medical management guidelines and an overall understanding of managed care Knowledge of the Genelco system. This position has contact with members, agents, human resource representatives, group contacts, health care providers, claims, administration, marketing, medical management and provider relations personnel.