PPO Customer Service Representative

About The Role
MagnaCare is seeking Customer Service Representatives to assist members, physicians, hospitals, and other healthcare providers with member benefits, eligibility, claims inquiry, claim reconsiderations and appeals. 

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
 
Primary Responsibilities
•    Greet customers in a courteous, friendly, and professional manner using agreed upon procedures.
•    Listen attentively to customer needs and concerns; demonstrate empathy and offer solutions.
•    Confirm customer understanding of the solution and provide additional customer education as needed.
•    Prepare complete and accurate work and update customer file.
•    Communicate effectively with individuals/teams in the program to ensure high quality and timely expedition of customer requests.
•    Effectively transfer misdirected customer requests to an appropriate party.
•    Contribute ideas on ways to resolve problems to better serve the customer and/or improve productivity.
•    Offer solutions to issues that are often non-standard/non-routine and require some clarification.
•    Perform other call center functions and support projects as directed by the management.
•    Balancing the demands of the caller with program requirements for quality, average handle time, and productivity. 
•    Use appropriate verbiage and level of detail to formulate and adapt the response to the level of understanding the caller has about the MagnaCare processes and specific plan details.
•    Calls will require the CSR to proactively educate the caller and validate understanding before completing the call.

Essential Qualifications
•    High School diploma.
•    Some college or business school education is a plus.
•    Knowledge of basic computer operations.
•    Intermediate knowledge of Microsoft Office and email writing.
•    Knowledge of CPT codes, ICD-9. Ability to learn quickly. 
•    Courteous with strong customer service orientation. 
•    Dependable with proficient attention to detail. 
•    Good listening and responding skills. 
•    Must be flexible with the ability to adapt to changes quickly and think conceptually.
•    Solid problem-solving skills.  
•    Excellent attendance, punctuality and work record required.
 
About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement  

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities.   We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace.  We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer

JOB ALERT FRAUD:  We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information.  Our h