The Word & Brown Companies

• Understanding of company policies and procedures as they apply to California Choice/Choice Builder plans. • Answers questions by telephone from groups regarding new hires, billings, rates, supplies, administrative procedures, etc. • Educates, via telephone, employees/dependents regarding PCP’s, ID cards, RX problems, administrative procedures, dependent coverage, address changes, etc. • Follows-up on calls and emails from brokers regarding problems that their groups are experiencing with providers. • Ability to interact with brokers, general agents and sales representatives on a daily basis and must be able to answer questions regarding California Choice processes. • Responds to calls from providers to confirm eligibility and benefits. • Verifies enrollments and resolves issues with carriers. • Expedites processing of members enrollment with carrier if urgent services are needed. • Review and submit appeal requests from groups. • Review /Audit group billing and explain to clients in clear and accurate manner. • Document calls in call tracking system. • Departmental standard requires each Customer Service Representative to provide Service of Unequalled Excellence to all callers by maintaining an average of 90% or greater on Call Reviews. • Answer at least 100% of the daily call volume average. • Provide clear and explicit documentation while maintaining percentage at a level of 90% or higher daily. • Make busy time of 20 minutes or less per day. • Meet department standards for quality and quantity of work. • Meet department and team standards for turnaround times. • Adhere to all HIPAA (Health Insurance Portability and Accountability Act) and PHI (Personal Health Information) guidelines. • On-site regular attendance and punctuality are essential functions of the job. • Performs other business tasks or functions as assigned.