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  • Middletown, RI 02842

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Customer Care Associate

American Cybersystems, Inc. (ACS Group) • Middletown, RI

Posted 15 days ago

Job Snapshot

Contract to Hire
Travel - None
Experience - 1 to greater than 15 years
Degree - High School
Healthcare - Health Services
Customer Service

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Job Description

ACS group has an immediate need for a Customer Care Associate with experience in the Healthcare Industry. This is a 3 months’ contract to hire opportunity and is located in Middletown RI 02842. Our client is a leading Healthcare organization.


Please review the job description below:


Key Responsibilities:

Job Profile Summary:

·         This position is a frontline service position providing assistance to members and providers regarding programs, policies, and procedures.

·         Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers.

·         Responsibilities also include the administration of intake documentation into the appropriate systems.

·         Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call.

·         Performance expectations are to meet or exceed operations production and quality standards.


Essential Functions:

·         Actively listens and probes callers in a professionally and timely manner to determine purpose of the calls.

·         Researches and articulately communicates information regarding member eligibility, benefits, EAP services, claim status, and authorization inquiries to callers while maintaining confidentiality.

·         Resolves customer administrative concerns as the first line of contact - this may include claim resolutions and other expressions of dissatisfaction.

·         Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.

·         Assist in the mentoring and training of new staff.

·         Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing trainings (formal and informal).

·         Comprehensively assembles and enters patient information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs.

·         Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and achieve its business and operational goals.

·         Educates providers on how to submit claims and when/where to submit a treatment plan.

·         Identifies and responds to Crisis calls and continues assistance with the Clinician until the call has been resolved.

·         Informs providers and members on appeal process.

·         Lead or participate in activities as requested that help improve Care Center performance, excellence and culture.

·         Links or makes routine referrals and triage decisions not requiring clinical judgment.

·         Performs necessary follow-up tasks to ensure member or providers needs are completely met.

·         Provides information regarding in-network and out-of-network reimbursement rates and states multiple networks to providers.

·         Refers callers requesting provider information to Provider Services regarding professional provider selection criteria and application process.

·         Refers patients/EAP clients to the Care Management team for a provider, EAP affiliate, or Facility.

·         Responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.

·         Support team members and participate in team activities to help build a high-performance team.

·         Thoroughly documents customers’ comments/information and forwards required information to the appropriate staff.

Job Requirements



·         HS Degree/GED

·         Minimum 6 months – 1-year call centre experience (pharmacy/specialty pharmacy preferred) – REQUIRED

·         CPT - PREFERRED

·         Specialty or retail pharmacy industry experience, previous reimbursement experience, and/or working in a health plan/health care setting - PREFERRED

·         Proficiency in Pharmacy computerized systems and software applications, as well as MS Office Product Suite – PREFERRED

·         Excellent written and verbal communication skills.

·         Ability to follow clinical criteria and instructions to approve prior authorization requests.

·         Ability to identify and trouble-shoot problematic issues.


Schedule: Monday-Friday 8:30am-5:00pm.


Additional information:

·         This is not a typical clinical role.

·         This is a CALL CENTER position, primarily outbound calls.


If it creates an interest for you, please email me the latest copy of your resume.


Thanks and regards,

Deepak Mishra | Sr. Associate- Recruitment

T: 678 – 606 - 0205

[Click Here to Email Your Resumé]


ABOUT ACS GROUP.ACS Group is a premier provider of IT Consulting, Engineering Consulting, Healthcare Solutions, Talent Solutions, and Workforce Management Solutions to Fortune 1000 companies globally. ACS Group conducts business through four operating brands – AIC, Analysts, ComforceHealth, and HireGenics – each with a specialized business focus. Our operating brands have provided targeted services and solutions for more than 50 years. Recognitions include: #1 Fastest Growing Company in the State of Georgia (2014); Ranked by SIA as the Second Largest Minority-Owned IT Consulting Company in the U.S. (2015); and winner of Inavero’s Best of Staffing® Client Diamond Award (2016). ACS Group is a certified MBE organization, and an NMSDC Corporate Plus® member, headquartered in Atlanta, Georgia, with offices across the U.S. and India, and an international presence in Canada and Latin America.


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