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West Corporation Plymouth Meeting Full-Time
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Responsible for assisting members in navigating the healthcare system by facilitating access to healthcare providers, benefit and entitled coverage information, health services, and health resources; receive calls from members in regards to various healthcare issues (e.g., infertility, disease, medication, etc.) and determine best course of action/s to assist the members while adhering to established policies, procedures, and key performance indicators (KPIs) (e.g. case close targets, abandon rates, etc.); communicate clear non-prescriptive messages to members in regards to planed activities, expected results, and anticipated timeframes of medical procedures and diagnoses; build relationships with members in order to collaborate and develop plans of action by going above and beyond members' initial requests, taking responsibility for members' case records, and encouraging members to call back with future issues/questions; facilitate communication among members, treating physicians, and insurance carriers, which may include assisting members with asking necessary health questions to physicians or clarifying insurance plan provisions
Education •Bachelor of Science in Nursing (BSN) or Registered Nurse (RN) degree from an accredited college or university is required Experience •Minimum of four years' experience in medical management, clinical nursing, case or disease management, health benefit plans, health insurance, home care services, or related field is required • Minimum of one year telephone triage or call center background preferred Other •Basic knowledge of MS Word, Outlook, and Excel required •A current/active and unrestricted state RN licensure is required •Based on area of assignment completion of applicable Health Insurance Portability and Accountability Act of 1996 (HIPAA) certifications may be required •A current/active and unrestricted multistate RN licensure or endorsements is preferred •Bilingual ability in English and Spanish is preferred A successful incumbent in the job will be able to demonstrate the following skills and abilities: •Strong communication skills and phone etiquette •Strong ability to explain complex issues to members in simple, understandable terms •Highly effective listening skills •Strong problems solving/issue resolution skills •Excellent customer service and customer resolution skills •Strong organizational and administrative skills •Ability to work in a team environment

Recommended skills

Customer Service
Active Listening
Registered Nurse Certified
Call Centers


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Job ID: 126223


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