Job Summary
Inbound call center to assist and educate members, employer groups, providers, colleagues, and/or agents of health plan benefits with accessing services, facilitating and resolving problems, understanding claims, billing and coding, along with other questions. Consistently create an exceptional experience with each contact, via inbound and outbound calls, face-to-face interactions, online chat, email, etc.

Essential Functions

• Analyzes, evaluates, resolves and responds to service inquires from members, providers, employer groups, colleagues, agents, Elite agents (customers), and others within departmental guidelines. Professional and pleasant interactions are ongoing expectations.
• Partnering with internal and external resources, promptly provides customers with information and education concerning benefit clarification, eligibility requirements, verification, authorization, billing and claim status.
• Promptly identifies and resolves or escalates customer concerns or complaints to achieve positive outcomes. Places outbound welcome calls to members to educate them on their benefits as needed. Assists walk-in members and agents if assigned by leadership.
• Adheres to established procedure and quality guidelines in support of Priority Health service promise, key drivers, performance indicators, as well as Corporate values and codes of excellence. Identifies potential trends or issues that impact health plan members and works with coworkers and leadership resources to suggest process improvements.
• Assists members with administrative issues, such as submitting enrollment record changes, providing letter explaining coverage or benefits, and obtaining and relaying certain member information to other departments as needed.
• Facilitates claims resolution through follow-up on member calls and correspondence received to appropriate departments.
• Effectively tracks and/or documents all service interactions with customers within appropriate systems according to guidelines.
• Develops and maintains behaviors of productivity, availability to customers, and adherence to work schedule.

Qualifications

• Required High School Diploma or equivalent
• Preferred Associate's Degree
• 1 year of relevant experience in related field Required

Primary Location

SITE - Lakeland Medical Center - 1234 Napier Ave - St Joseph

Department Name

Contact Center - Lakeland

Employment Type

Part time

Shift

Variable (United States of America)

Weekly Scheduled Hours

4

Hours of Work

0-40

Days Worked

Varies

Weekend Frequency

Variable weekends

CURRENT SPECTRUM HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Spectrum Health team members only.

Spectrum Health is committed to providing a safe environment for our team members, patients, visitors and community. That is why we require a drug-free workplace and various vaccinations as a requirement for employment.

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

If you are a qualified individual with a disability, you may request assistance in completing the application process by calling 616.486.7447. We are committed to granting reasonable accommodations in accordance with applicable laws.