Position Summary
Customer Service Professionals (CSP's) are responsible for first line of support for Inbound contact center. Provide an easy, efficient and productive customer experience for callers. Their duties include handling many inbound and outbound calls to and from customers, listening to customers needs or issues and providing helpful solutions to their inquiries. In addition, customer service professionals are responsible for the intake of Physical Medicine referrals, scheduling of patients with in network providers and communication to adjuster and nurse case managers.
Primary Duties & Responsibilities
- Receive inbound phone and electronic referrals from workers compensation insurance companies, nurse case managers, providers, doctors, patients etc.
- Open new cases accurately according to policy and procedures.
- Make outbound telephonic/electronic contacts with adjusters and Physical Therapy Centers to verify new case information/missing information and request other related paperwork.
- Communicate with adjusters and nurse case managers regarding updates on patient status in a timely manner.
- Maintain TAA goal (Total Agent Availability) monthly.
- Consistently meet MedRisk Customer Support Service & Quality standards (call monitoring and EOC monitoring).
- Review case information/consult with Case Management to determine if new cases need to be opened or patient can be followed in existing case.
- Validate new case data by reviewing, correcting, deleting, or re-entering data; combining data when account information is incomplete; purging files to eliminate duplication of data.
- Request verification from insurance companies and other related paperwork from providers telephonically/electronically.
- Make outbound calls to Providers and Patients in order to schedule patient's Physical Therapy
- Understand MedRisk's interdepartmental procedures, policies and comply with them.
- Identify potential or existing system and/or procedural challenges, and notify Supervisor and assist in resolution if needed.
- Complete special projects or tasks as assigned by the supervisor.
- Apply knowledge of and adhere to the URAC Utilization Management Standards
