Job Summary

The Contact Center Representative (CCR) II is the first point of contact for members, providers, and stakeholders, delivering complete, accurate and compassionate support on moderately complex issues related to eligibility, benefits, claims, authorizations, Primary Care Physician (PCP) changes, and other service needs ensuring seamless triage across the healthcare journey. The CCR II delivers a high-quality service experience that supports member retention and health outcomes.

The CCR II focuses on all managed care product lines, with an in-depth understanding of Commercial and Medicare products.

Duties

Responds to inquiries across all channels related to eligibility, benefits, claims, authorizations, and coordination of care. Assists members with navigating their healthcare journey, including understanding their eligibility and benefits, Evidence of Coverage (EOC) and Member Handbook. Provides First Call Resolu...