Job SummaryCustomer Service Professionals (CSPs) serve as the primary support for the inbound contact center, ensuring a seamless, efficient, and productive experience for callers. Their responsibilities include managing a high volume of inbound and outbound calls, actively listening to customers' needs or concerns, and offering effective solutions to their inquiries. Additionally, CSPs handle the intake of Physical Medicine referrals, coordinate patient scheduling with in-network providers, and communicate relevant information to adjusters and nurse case managers.Primary Duties & Responsibilities
- Receive inbound phone and electronic referrals from workers' compensation insurance companies, nurse case managers, providers, doctors, and patients.
- Accurately open new cases in accordance with established policies and procedures.
- Make outbound calls and electronic contacts with adjusters and Physical Therapy Centers to verify new or missing case information and request related paperwork.
- Communicate timely updates on patient status to adjusters and nurse case managers.
- Maintain monthly Total Agent Availability (TAA) goals.
- Consistently meet MedRisk Customer Support Service and Quality standards, including call and EOC monitoring.
- Review case information and consult with Case Management to determine if new cases should be opened or if patients can be followed under existing cases.
- Validate new case data by reviewing, correcting, deleting, or re-entering information; merging data when account information is incomplete; and purging files to eliminate duplication.
- Request verification and related paperwork from insurance companies and providers via phone or electronic communication.
- Make outbound calls to providers and patients to schedule physical therapy appointments.
- Understand and comply with MedRisk's interdepartmental procedures and policies.
- Identify potential or existing system and procedural challenges, and notify the supervisor to assist in resolution as needed.
- Complete special projects or tasks as assigned by the supervisor.
- Apply knowledge of and adhere to URAC Utilization Management Standards.
- Perform other duties as assigned.
Qualifications
- Bachelor's degree preferred or equivalent industry experience.
- At least 3 years of call center experience with both inbound and outbound calls in a medium to high-volume setting.
- Exceptional verbal and written communication skills, showcasing a positive, can-do attitude.
- Strong problem-solving abilities.
- Proficient data entry skills.
- Detail-oriented with solid organizational capabilities.
- Proficient in Microsoft Word, Excel, and Outlook.
- Ability to multitask effectively and work independently.
- Bilingual in English and Spanish is a plus, as bilingual Customer Service Professionals assist with communication for Spanish-speaking clients.