CUSTOMER SERVICE SPECIALIST - LIBERTY ADVANTAGE

Liberty Health; Wilmington (NC); Sur place; USD 38 000 - 48 000; Plein temps

Résumé du poste

Liberty Advantage is seeking a dedicated Customer Service Specialist to support members and providers with escalated issues and enrollment tasks. This full-time role emphasizes education on benefits, claims information, and coordination with care providers to ensure timely assistance.

Responsibilities include resolving appeals, researching complex issues, and triaging prior authorizations. The candidate should have strong communication skills and the ability to work independently in a fast-paced

Qualifications

• Excellent listening, verbal, written and interpersonal communication skills.
• High level of professionalism and confidentiality with a strong customer service focus.
• Can adapt to operational needs with excellent follow-up skills.
• Must be self-motivated with the discipline to work independently.
• Must have a valid driver’s license.
• Proven ability to communicate concisely with all staff levels.

Responsabilités

• Handle escalated calls from members/providers or vendors resolving issues, preferably the first time.
• Educate members on benefits and resolving claim information or setting up enhanced benefits.
• Intervene with care providers for appointment scheduling or connections with internal specialists.
• Assist with enrollment team to set up new members.
• Document and resolve Appeals and Grievances within CMS time frames.
• Research complex issues across databases and collaborate to resolve escalated issues.
• Set up and triage prior authorization requests, working through clinical protocols.

Connaissances

Customer service

Communication

Confidentiality

Self-motivation

Driver's license

Formation

High School Diploma/GED

Description du poste

With Compassion

Liberty Advantage Is Currently Seeking An Experienced

CUSTOMER SERVICE SPECIALIST

Full Time

• Handle escalated calls from members/providers or vendors resolving issues, preferably the first time.
• Help educate members on the benefits that are available to them, whether this is resolving claim information, setting up enhanced benefits….
• Intervene with care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialist for assistance when needed
• Assist with enrollment team to set up new members
• Document and resolve any Appeals and Grievances within required time frames as set by CMS
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or collaborate with others to resolve escalated issues.
• Set-up and triage prior authorization requests, working through clinical protocols.

Liberty Cares

With Compassion

Liberty Advantage Is Currently Seeking An Experienced

CUSTOMER SERVICE SPECIALIST

Full Time

Job Summary

• Handle escalated calls from members/providers or vendors resolving issues, preferably the first time.
• Help educate members on the benefits that are available to them, whether this is resolving claim information, setting up enhanced benefits….
• Intervene with care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialist for assistance when needed
• Assist with enrollment team to set up new members
• Document and resolve any Appeals and Grievances within required time frames as set by CMS
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or collaborate with others to resolve escalated issues.
• Set-up and triage prior authorization requests, working through clinical protocols.

Job Requirements

• High School Diploma/GED (or higher) OR equivalent work experience
• Minimum of 3+ years of combined education, work and/or volunteer experience
• Experience in Health Care Customer Service desirable
• Excellent listening, verbal, written and interpersonal communication skills.
• High level of professionalism and confidentiality, with a strong customer service focus.
• Can adapt well to operational needs with excellent follow-up skills.
• Must be self-motivated, with a work ethic of dedication and the discipline to work independently.
• Must have a valid driver’s license.
• Proven ability to communicate concisely and confidently with all staff levels. Can clearly communicate instructions to remote users.

Background checks/drug-free workplace.

EOE.