Customer Care Specialist Sr

Prime Therapeutics • Home, WV

8d • $19 - $29

About The Position

The Senior Customer Care Specialist is responsible for delivering exceptional support to members and providers by addressing inquiries related to eligibility, benefits, claims, and service authorizations. The role serves as a subject matter expert and resource for complex issues, ensuring accurate and timely resolution while maintaining a high standard of service.

Requirements

• High school diploma from an accredited school or equivalent GED
• 2 years of work experience in customer service
• Must be eligible to work in the United States without the need for work visa or residency sponsorship
• Must be flexible in scheduling and comfortable with change
• Strong typing proficiency (avg. 35+ WPM) with strong written and verbal communication skills
• Demonstrated ability to multi-task and maneuver through various computer platforms while verifying information on all calls
• Familiarity with medical terminology, healthcare procedures, and insurance-related language to effectively support member and provider inquiries
• Knowledge of HIPAA regulations and other healthcare compliance standards
• Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
• Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Nice To Haves

• 3 years work experience in customer service in healthcare
• Previous experience with Genesys or CRM technology platforms

Responsibilities

• Engage inbound callers professionally; actively listen and probe to determine the purpose of the call and resolve administrative concerns, including claims and dissatisfaction
• Research and communicate member information such as eligibility, benefits, Employee Assistance Program (EAP) services, claims, and authorizations while maintaining confidentiality
• Identify and escalate operational inefficiencies; ensure follow-up to fully meet member or provider needs and support continuous improvement
• Support team development by mentoring new staff and participating in initiatives that enhance Care Center performance and culture
• Initiate care programs by accurately assembling and entering patient data into appropriate systems for EAP, Care, and Utilization Management
• Educate providers on claims submission, treatment plans, and appeal processes to ensure proper procedures are followed
• Respond to crisis calls and assist clinicians until resolution, ensuring appropriate support is provided
• Make routine referrals and triage decisions, including directing callers to appropriate teams or resources and providing reimbursement and network information
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees