• Provide a high degree of customer service and professionalism when interacting with the patients of providers via the phone or email; ability to empathize and diffuse difficult situations professionally and in a caring manner • Assist members with detailed provider searches utilizing network look-up tools • Assist members navigating our digital programs and serve as a conduit for escalations and questions • Contact provider offices or facilities to obtain needed prior authorization pieces such as additional medical records, forms, facility location or Tax ID numbers for claims billing • Assist with claims work such as adjusting site of service • Protect/observe patient privacy and confidentiality, per external regulatory requirements (HIPAA) and internal policy and procedures • Ensures compliance with applicable URAC and NCQA accreditation guidelines and state and federal regulations