Provider Services / Customer Service

October 4, 2021
San Francisco, CA
Job Type


Provider Services / Customer Service 

This is a Remote position

Call center hours 7-7pmCST M-F will need to be available and will be provided a perm schedule

Pay $17-18 hour

Summary: This position primarily answers incoming calls for new and existing authorizations. Responsibilities include documenting in the appropriate systems and ensuring high quality and accurate information is provided to callers. This role is expected to meet or exceed operations production and quality measures.

Job Duties: 
High volume call center

  • Responsive for meeting call metrics
  • Approx. 80-100 calls per day – will take calls from members, doctor offices and imaging providers
  • Understands the end to end authorization process, the SBU's business and business drivers for success.
  • Actively listens and probes callers in a professional and timely manner to process authorizations and/or other customer service requests working towards first call resolution.
  • Researches and communicates information regarding member eligibility, provider status and authorization inquiries to callers while maintaining confidentiality.
  • Resolves customer complaints or concerns as the first line of contact.
  • Makes problem resolution and triage decisions not requiring clinical judgment.
  • Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
  • Transfers calls to clinicians and physicians only for clinically escalated situations.
  • Communicates appeal and denial language to providers and members when appropriate.
  • Processes withdrawals and other case status changes as needed.
  • Understands client and regulatory expectations for accounts in their designated region.
  • Recognizes and develops relationships with provider groups through repeat calls, and recognizes provider sensitivities for different health plans.
  • Is responsible for reading and retaining information disseminated through multiple resources, ensuring calls are handled accurately and appropriately per current account information.
  • Processes fax attachments in between calls.
  • Responsible for meeting SBU's Service standards in all categories on a monthly basis, team player, maintain member and provider Confidentiality at all times, demonstrate effective problem solving skills, and be punctual and maintain good attendance.
  • Participates in SBU's Service Operations activities as requested that help improve Care Center performance, excellence and culture.
  • Supports team members and participate in team activities to help build a high-performance team.
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