Support Specialist

🔥 1 minute ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $40.2k - $54.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💝 Customer Support

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requests • Review intake documents for pre-approved services and escalate discrepancies as needed • Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify issues or risk factors requiring clinical escalations to a CM/PCM • Initiate and finalize authorization in Trucare for preapproved services and DMEs; update and discontinue authorizations when applicable • Handle and accurately document calls to and from members regarding benefit questions/issues, appointments, assessment inquiries, service issues and grievances • Handle and accurately document calls to and from providers regarding authorization initiation/updates, referrals, visits, tests and faxed care plans • Provide education to members and providers regarding requirements for approval of service requests • Manage a large caseload while communicating member issues or needs and monitoring screening of members to improve quality and cost outcomes • Communicate with Inter/Intra-departments regarding reconciling onboarding issues • Handle member mailings and fax clinical requests and approved authorized service plans • Perform additional duties as assigned

🎯 Requirements

• High School diploma or GED equivalent • Experience in a customer service environment • Experience working in a fast-paced environment that requires handling multiple priorities simultaneously • Work experience requiring effective communication verbally and in writing while demonstrating good grammar, spelling, and punctuation skills • Preferred: Associate Degree/Certification in a related field • Preferred: English proficient bilingual who also speaks Spanish or Mandarin/Cantonese • Preferred: Knowledge of medical terminology • Preferred: Knowledge of Trucare, Salesforce, HHAXchange, DocuSign Epaces, Sharepoint • Preferred: Experience in managed care or other area of the healthcare industry working in a Call Center environment or Care/Case Management Department • Preferred: Experience with Microsoft Office Suite applications including Excel, Word, Outlook, and MS Teams • Preferred: Demonstrated ability to document calls into a computer system

🏖️ Benefits

• Medical, dental and vision coverage • Incentive and recognition programs • Life insurance • 401k contributions (all benefits are subject to eligibility requirements) • Competitive compensation and benefits package

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