Intake Representative - CFHP

Community First Health Plans; San Antonio (TX); On-site; USD 35,000 - 45,000; Full time

Job summary

A leading health plan provider in San Antonio is looking for a customer service representative to determine member eligibility and provide administrative support in utilization management systems. The role requires a high school diploma, strong data entry skills, and three years of customer service experience. Familiarity with medical terminology and call center standards is essential. This position involves handling telephonic requests and maintaining accurate records.

Qualifications

• Three or more years of recent customer service experience, preferably in a managed care setting.
• Must be computer literate and possess data entry and typing skills.
• Working knowledge of customer service and call center standards.

Responsibilities

• Acts as the first point of contact for all telephone calls to the UM area.
• Determines member and provider eligibility status of authorization requests.
• Provides administrative and technical support in the UM systems/databases.

Skills

Customer service experience

Data entry skills

Technical support

Knowledge of medical terminology

Education

High school diploma or equivalent

Courses in business functions

Job description

POSITION SUMMARY RESPONSIBILITIES

Is the first point of contact for all telephone calls to the UM area. Determines member and provider eligibility status of telephonic and faxed authorization requests. Provides administrative and technical support for utilization and case management activities in the UM systems/databases. Reviews pended authorization reports and updates to completion in a timely manner.

EDUCATION/EXPERIENCE

A high school diploma or equivalent experience is required. College or commercial school courses in business functions are preferred. Must be computer literate and possess data entry and typing skills as well as accuracy in administrative duties. Three or more years of recent customer service experience, preferably in a managed care setting, is required. Working knowledge of medical terminology, customer service standards, and call center standards is required.