Assists in resolving customer concerns, providing appropriate education/instruction and maintaining customer satisfaction by providing the highest level of customer service within the phone system. Assists and educates callers about available services through active listening, problem solving, interpreting complex human problems, researching information, contacting providers and providing caller information. Assists callers with special needs or crisis situations by helping to identify the problem(s) through interviewing skills, identifying primary and secondary resources, by discussing options with the caller, and helping the caller decide on the plan of action. Advocates for callers who are incapacitated by age, physical or mental illness or handicap, or who are otherwise unable to communicate with various service delivery systems effectively.
Determines if services are covered benefits as applicable by line of business and product design.
Responds to questions from customers and prospective customers.
Serves as the primary contact for behavioral health benefits and network for members and providers.
Investigates all concerns/issues to assure accurate information is provided in a timely manner.
Completes resolution for all member/provider concerns and inquiries.
Provides daily support and advice to member/provider services staff regarding benefits.
Manages crisis situations with members and triages appropriately.
Collects and records data on callers' needs for use in monthly statistical and activity reports.
Collects and records data on behavioral health organizations, facilities and services.
Prepares, generates and appropriately disseminates letter communications to subscribers and members.
Provides training within the team as needed.
Communicates and coordinates with the appropriate internal department to resolve issues.
Provides team building resources to assist in directing peers to appropriate policies and procedures in order to assist members and providers.
Completes outbound calls to providers and members to resolve complex benefit, eligibility and claims issues.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
*Hours: Monday - Friday, 8am - 4:30pm. No weekends or holidays!
*Travel to Geisinger locations once a month is required.
*Experience providing behavioral health services or working in the behavioral health field is preferred.
*Geisinger offers comprehensive suite of healthcare benefits all starting day one of employment! This includes medical, prescription drug, vision and dental coverage. We also offer up to $5,000 tuition reimbursement and 5% contribution to your retirement plan.
Associate's Degree-Social Sciences (Required)
Minimum of 1 year-Related work experience (Required)
Certification(s) and License(s)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.