• Answer incoming patient calls promptly and professionally • Schedule, reschedule, and confirm patient appointments • Accurately register and update patient information in the system • Handle patient inquiries and provide basic information as needed • Ensure all patient data is handled in compliance with HIPAA regulations • Coordinate with clinical staff to support smooth daily operations

• Comunicar regularmente con los clientes para proporcionar actualizaciones del caso y responder preguntas • Coordinar con los abogados para asegurar que los clientes reciban la atención médica adecuada • Abrir y gestionar reclamos ante compañías de seguros; responder a consultas y solicitudes • Solicitar, organizar y dar seguimiento a registros médicos y facturas junto con el equipo administrativo • Mantener expedientes de casos actualizados y precisos utilizando software de gestión de casos • Colaborar estrechamente con los equipos internos para asegurar el progreso eficiente de cada caso

• Resolve member complaints and escalated issues, ensuring a satisfactory outcome. • Document and track escalated issues, maintaining clear and comprehensive records from initiation to resolution. • Manage casework queues in Customer Relationship Management tool (Microsoft Dynamics). • Research account history, notes, treatment plans and settlement documents to identify escalation root cause and devise positive outcomes. • Consult with various departments including Claims, Rx and Sales to gather information and coordinate efforts in devising effective solutions. • Manage inbound call volume. • Outreach to providers, pharmacies, and members to obtain additional information as needed. • Develop and implement strategies to reduce the volume of escalated issues by identifying drivers, patterns, and trends. • Demonstrate proficiency in problem-solving and thinking critically when it comes to resolving member complaints. • Communicate effectively with members, internal teams, and management. • Ability to explain coverage determinations. • Identify and recommend ways in which our Member Care team can further build connections through empowerment and ownership. • Ensure familiarity with the most up-to-date policies and procedures and recognize potential additions or modifications as needed. • Share opportunities for learning and development on member issues and potential improvements based on trend analysis with management and other team members.

• Provide telephonic case management to medically complex and chronically ill members • Conduct comprehensive health assessments and create individualized care plans • Coordinate care with internal and external partners, including physicians and specialists • Educate members and caregivers on disease management and preventive care • Monitor member progress and advocate for timely, appropriate interventions • Identify and help resolve service or access issues impacting care quality