Managed Care Coordinator I

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🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $44.6k - $59.7k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

Insurance

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 Description

• Supports Clinical Operations functions and acts as liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators • Performs review of service requests for completeness of information and collection of non-clinical data • Initiates call backs and correspondence to members and providers to coordinate and clarify benefits • Handles initial screening for pre-certification requests via calls or correspondence based on scripts and workflows • Assists members with finding providers, resolving problems and answering questions regarding services • Makes outbound calls to engage members in Case Management and to complete necessary health assessments • Educates members regarding preventive health activities and services • Review medical and administrative documentation for accuracy and compliance standards

🎯 Requirements

• High School Diploma/GED required • Prefer 1-2 years customer service or medical support related position • Requires knowledge of medical terminology • Requires Good Oral and Written Communication skills • Requires ability to make sound decisions under the direction of Supervisor • Prefer knowledge of contracts, enrollment, billing & claims coding/processing • Prefer knowledge Managed Care principles • Prefer the ability to analyze and resolve problems with minimal supervision • Prefer the ability to use a personal computer and applicable software and systems

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement