Customer Care Associate MediCal Korean
Company: Magellan Health
Location: Rancho Cordova
Posted on: May 12, 2022
Provides assistance to Magellan's members and providers
regarding programs, policies, and procedures. Responsibilities
include answering incoming calls related to eligibility, benefits,
claims and authorization of services from members or providers.
Responsibilities also include the administration of intake
documentation into the appropriate systems. Overall expectations is
to provide outstanding service to internal and external customers
and strive to resolve member and provider needs on the first call.
Performance expectations are to meet or exceed operations
production and quality standards.
- Listens and probes callers in a professionally and timely
manner to determine purpose of the calls.
- Researches and articulately communicates information regarding
member eligibility, benefits, EAP services, claim status, and
authorization inquiries to callers while maintaining
- Resolves customer administrative concerns as the first line of
contact - this may include claim resolutions and other expressions
- Assist efforts to continuously improve by assuming
responsibility for identifying and bringing to the attention of
responsible entities operations problems and/or
- Assist in the mentoring and training of new staff.
- Assume full responsibility for self-development and career
progression; proactively seek and participate in ongoing trainings
(formal and informal).
- Comprehensively assembles and enters patient information into
the appropriate delivery system to initiate the EAP, Care and
Utilization management programs.
- Demonstrate flexibility in areas such as job duties and
schedule in order to aid in better serving members and help
Magellan achieve its business and operational goals.
- Educates providers on how to submit claims and when/where to
submit a treatment plan.
- Identifies and responds to Crisis calls and continues
assistance with the Clinician until the call has been
- Informs providers and members on Magellan's appeal
- Lead or participate in activities as requested that help
improve Care Center performance, excellence and culture.
- Links or makes routine referrals and triage decisions not
requiring clinical judgment.
- Performs necessary follow-up tasks to ensure member or
provider's needs are completely met.
- Provides information regarding Magellan's in-network and
out-of-network reimbursement rates and states multiple networks to
- Refers callers requesting provider information to Provider
Services regarding Magellan's professional provider selection
criteria and application process.
- Refers patients/EAP clients to the Magellan's Care Management
team for a provider, EAP affiliate, or Facility.
- Responsible for updating self on ever changing information to
ensure accuracy when dealing with members and providers.
- Support team members and participate in team activities to help
build a high-performance team.
- Thoroughly documents customers comments/information and
forwards required information to the appropriate staff.Other Job
Requirements ResponsibilitiesMust be bilingual.Must be flexible in
scheduling and comfortable with change as customer service is an
ever-changing environment.Responsible for meeting call handling
requirements and daily telephone standards as set forth by
management.Must agree to observing service for the purpose of
training and quality control. -Proficient typist (avg. 35+ WPM)
with strong written and verbal communication skills.Must be able to
maneuver through various computer platforms while verifying
information on all calls.Must be able to talk and type
simultaneously.General Job Information TitleCustomer Care Associate
MediCal Korean Grade17 Work Experience - RequiredCustomer Service
Work Experience - Preferred Education - RequiredGED, High School
Education - PreferredAssociatesLicense and Certifications -
RequiredLicense and Certifications - Preferred Magellan Health,
Inc. is proud to be an Equal Opportunity Employer and a
Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must
understand, comply with and attest to the security responsibilities
and security controls unique to their position; and comply with all
applicable legal, regulatory, and contractual requirements and
internal policies and procedures.
Keywords: Magellan Health, Rancho Cordova , Customer Care Associate MediCal Korean, Healthcare , Rancho Cordova, California
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