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Anthem, Inc. Customer Service Coordinator (myNEXUS) in Costa Mesa, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At myNEXUS, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

myNEXUS is a technology-driven, care and benefit management service that enables individuals to live healthier lives in their homes. Our proven clinical model connects individuals to intelligent care delivering independence at lower costs. To maximize health delivery, we consistently leverage our: Innovative Technologies, Advanced Clinical Expertise, and Proprietary Network Engagement Platform. We are continuously pioneering ways to optimize health resources for our clients and their customers. Through our proprietary network management and engagement programs, we realize enhancements in quality, outcomes, and care effectiveness.

Job Summary:

The Service Delivery Coordinator-Customer Service Focus is the front line of the company. This person is responsible for answering all incoming calls from our clients and customers, processing referrals via phone, triaging and troubleshoot both internal and external portal support concerns and making outbound calls to follow up on documentation needed to process referrals. This person is responsible for accurately documenting all calls and periodically interacting with clinical staff and other team members across the organization. This position requires excellent communication, attention to detail, ability to work in a fast-paced environment and interpersonal skills. A high level of professionalism and problem-solving skills are a must. This person may also be required to assist with other service delivery duties if business need arise.

Duties/Responsibilities:

  • Answers the telephone and patient/provider requests in a timely and polite manner.

  • Using discretion and independent judgment in handling patient or physician complaints received, documents and forwards to appropriate administrative staff.

  • Escalates abnormal issues to Team Lead or Manager, making recommendations for resolution.

  • Communicates with patients, family, case managers and all other customers in a kind and professional manner.

  • Gives accurate explanations and verbal reassurances to all customers (both internally and externally).

  • Willing to assist with additional tasks and departments with in Service Delivery.

  • Interacts professionally with all, including co-workers and other healthcare providers.

  • Fosters communication among healthcare team on the behalf of the patient.

  • Proficient with myNEXUS systems, operations processes, data entry, and basic computer skills for generation of daily office communication and record generation.

  • Communicates ideas for improvement to the supervisor.

  • Demonstrate proficiency in meeting and exceeding all required departmental goals and objectives.

  • Reflects knowledge and judgment in decisions and actions within the job description of the Service Delivery Coordinator-Customer Service Focus.

  • Accurately and timely troubleshoots portal concerns and troubles. Communicates with various teams and departments to timely resolve any external portal concerns.

  • Must be able to demonstrate team behavior and must be willing to promote a team-oriented environment.

  • Maintains complete and accurate patient care records within company platform

    Professional Responsibilities:

  • Completes all compliance related training and demonstrates compliance on the job.

  • Adheres to dress code, appearance is neat and clean.

  • Completes annual education requirements.

  • Always maintains patient confidentiality as well as following all PHI guidelines and requirements .

  • Reports to work on time and from breaks as scheduled, completes work within designated time.

  • Follows all company policies related to time records and time off policies.

  • Attends annual review and department in-services, as scheduled.

  • Attends at staff meetings and one on one meetings as scheduled and reads all staff meeting minutes and other written documents as requested.

  • Represents the organization in a positive and professional manner.

  • Actively participates in performance improvement and continuous quality improvement (CQI/QA) activities and programs.

  • Complies with all organizational policies regarding ethical business practices.

  • Communicates and demonstrates the mission, ethics and goals of the Company, as well as the department.

    Required Skills/Abilities:

  • Responsible for processing incoming and outstanding fax processing and assigning to the appropriate myNEXUS team member when business needs arise.

  • Takes part in redefining the customer service process to meet the ever-changing needs of customers.

  • Able to deescalate situations in a professional and polite manner.

  • Demonstrates high level customer service skills, both internally and externally.

  • Manages workload, ability to self-direct tasks and able to delegate tasks and work appropriately and timely. Maintains expected call handle times, average speed of answer, time available in the phone queue and other expected metrics so myNEXUS meets contractual agreements.

  • Accepts additional assignments willingly.

  • Supports the Mission and the Core Values of myNEXUS.

  • Performs other duties as assigned.

  • Shows proficiency with computer programs which may include Microsoft Word, Excel, PowerPoint, Outlook and others.

  • Strong administrative, clerical and organizational skills.

  • Excellent customer service and follow-up skills.

  • Strong attention to detail and accuracy.

  • Ability to respond to common inquiries or complaints from providers, patients or family members.

  • Must demonstrate the willingness to work in a team environment and be a team player.

  • Possesses the ability to adjust to constantly changing work flows and processes.

    Education and Experience:

  • 1-2 Years of phone customer service and/or call center experience required.

  • High School diploma or the equivalent.

  • Ability to read and communicate effectively in English.

  • Additional languages preferred.

  • Must understand and communicate effectively with providers and insurance representatives.

    Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For® , is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS49979

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