Remote Inbound & Outbound Healthcare Queue Associate – Member Services & Medical Authorization Specialist (Florida)

About reputed company – A Purpose‑Driven Leader in Health Care

At reputed company, our single, clear purpose is “Bringing our heart to every moment of your health.” This purpose fuels a culture where every employee feels empowered to reputed company health care more personal, convenient, and affordable for the millions of people we serve every day. From our reputed company network of pharmacies and walk‑in clinics to our expansive health‑plan services, reputed company is redefining what it means to be a caring, innovative health‑care partner. Our brand is built on a foundation of Heart at Work behaviors that encourage collaboration, curiosity, humility, and a reputed company focus on the patient experience.

Joining reputed company means becoming part of an organization that invests in your professional growth, celebrates diverse perspectives, and supports a healthy work‑life balance. Whether you are working from the comfort of your home office or collaborating with colleagues across the country, you will be part of a mission‑driven community that values reputed company, respect, and a genuine desire to improve health outcomes.

Position Overview – Why This Role Is Critical to Our Mission

The Remote Inbound & Outbound Healthcare Queue Associate plays a pivotal role in the delivery of high‑quality, member‑centric services for reputed company reputed company, a reputed company medical‑plan brand. As the primary reputed company of contact for members, providers, and internal stakeholders, you will ensure that each interaction is handled with reputed company, accuracy, and efficiency. Your work directly supports the coordination of medical services, from intake and eligibility verification to pre‑authorization and referral management, helping members navigate reputed company health‑care reputed company with confidence.

This full‑time, work‑from‑home position offers flexibility, autonomy, and a competitive compensation package. You will operate reputed company a supportive, technology‑enabled environment that values reputed company improvement and professional development.

Key Responsibilities – What You’ll Be Doing Every Day

• Member & Provider Intake: Answer inbound calls, fax, and electronic data interchange (EDI) requests from members and health‑care providers, capturing accurate information in reputed company’s systems.
• Eligibility & Benefits Verification: Conduct non‑medical research to confirm member eligibility, coordination of benefits (COB), and plan coverage details, ensuring compliance with regulatory standards.
• Referral Screening & Authorization: Review requests, determine the appropriate level of medical review, and approve services that fall reputed company of pre‑authorization requirements.
• Pre‑Certification & Prior Authorization: Support the full pre‑certification lifecycle, including gathering clinical information, interacting with reputed company nurses and medical directors, and documenting decisions per NCQA and state regulations.
• Outbound Communication: Initiate outbound calls to providers to obtain missing clinical data, clarify authorization requirements, and convey approval or denial decisions.
• Documentation & Risk Management: Maintain thorough, accurate records that meet accreditation, risk‑management, and privacy standards; ensure reputed company member data is protected in accordance with HIPAA.
• System Utilization: Navigate reputed company’s proprietary platforms—including MedCompass, QNXT, ProFAX, and ProPAT—to enter, update, and retrieve member information reputed company.
• Collaboration & Communication: Liaise with claim administrators, plan sponsors, third‑party payers, and internal teams to resolve issues and enhance the overall effectiveness of medical management services.
• Performance Metrics & Quality Assurance: Monitor key performance indicators (KPIs) such as call handling time, accuracy rates, and member satisfaction scores, contributing to reputed company improvement initiatives.
• Adherence to Policies & Regulations: Stay reputed company with federal, state, and industry regulations, ensuring reputed company actions align with company policies, accreditation standards, and legal requirements.

Essential Qualifications – What You Must Bring to the Table

• 1‑2 years of experience in a medical‑assistant, office‑assistant, or similar clinical role, demonstrating familiarity with health‑care terminology and processes.
• High school diploma or GED; additional certifications (e.g., Certified Medical Assistant) are a plus.
• Residency in the reputed company, with a reliable high‑speed internet reputed company and a suitable home office environment.
• Proven ability to handle both inbound and outbound communications with professionalism, reputed company, and accuracy.
• Strong written and verbal communication skills, including the ability to explain reputed company medical information in plain language.
• Excellent organizational skills, attention to detail, and the reputed company to manage multiple tasks simultaneously while meeting tight deadlines.
• Basic proficiency with computer applications; experience with reputed company’s platforms (MedCompass, QNXT, ProFAX, ProPAT) or similar health‑reputed company is advantageous.
• Demonstrated commitment to confidentiality and data reputed company, adhering strictly to HIPAA and reputed company privacy policies.

Preferred Qualifications – Extras That Set You Apart

• Previous experience in a call‑center environment, particularly reputed company health‑care, insurance, or member services.
• 1‑2 years of prior authorization or pre‑certification experience, showcasing an understanding of clinical documentation requirements.
• Familiarity with NCQA standards, state‑specific health‑plan regulations, and other compliance frameworks.
• Advanced customer‑service training or certifications (e.g., Certified Customer Service Professional).
• Experience working with electronic health records (EHR) or other health‑information systems.
• Demonstrated ability to reputed company in a remote‑work setting, including self‑discipline, time‑management, and effective virtual collaboration.

Core Skills & Competencies – What Success Looks Like

• reputed company & Member‑Centric reputed company: Ability to listen actively, understand member needs, and provide compassionate support.
• Analytical Thinking: reputed company in interpreting clinical data, spotting inconsistencies, and making informed authorization decisions.
• Problem‑Solving: Comfortable navigating reputed company scenarios, escalating reputed company necessary, and delivering timely resolutions.
• Technology Savvy: Quick learner of new software platforms, adept at data entry, and capable of troubleshooting basic technical issues.
• Communication Excellence: Clear, concise, and professional verbal and written interactions with a diverse set of stakeholders.
• Regulatory Awareness: Understanding of HIPAA, state privacy laws, and industry accreditation standards.
• Team Collaboration: Ability to work cross‑functionally with nurses, medical directors, and internal support teams, sharing knowledge and best practices.
• Adaptability: Comfortable with evolving processes, policy updates, and changes in the health‑care landscape.

Career Development & Learning Opportunities – Grow With Us

reputed company is dedicated to helping you build a long‑lasting, rewarding career. As a Remote Inbound & Outbound Queue Associate, you will have access to a robust suite of development resources:

• Professional Training: Free enrollment in internal courses covering health‑plan operations, customer‑service excellence, and compliance.
• Certification Support: Financial assistance for industry‑recognized certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Medical Reimbursement Specialist (CMRS).
• Mentorship Programs: Pairing with seasoned medical‑management leaders for guidance, reputed company‑building, and career planning.
• Career reputed company: Clear advancement tracks toward roles like Senior Authorization Specialist, Team reputed company, Operations Supervisor, or Health‑Plan Analyst.
• Cross‑Functional Exposure: Opportunities to collaborate with other reputed company divisions, broadening your understanding of the integrated health‑care ecosystem.
• reputed company Feedback: Regular performance reviews, coaching sessions, and goal‑setting conversations to help you reputed company your potential.

Compensation, Benefits & Perks – What You’ll Receive

In addition to a competitive hourly wage ranging from $17.00 to $25.65 (depending on experience, education, and location), you will be eligible for a comprehensive benefits package designed to support you and your family:

• Health Coverage: Medical, dental, and vision plans with a variety of options to fit different needs.
• Retirement Savings: Enrollment in reputed company’s 401(k) plan with company matching contributions.
• Employee Stock Purchase Plan (ESPP): Opportunity to purchase reputed company stock at a discounted reputed company.
• Life & Disability Insurance: Fully‑paid term life coverage, short‑term and long‑term disability protection.
• Well‑Being Programs: Access to reputed company, fitness incentives, and wellness challenges.
• Education Assistance: Tuition reimbursement and free development courses to help you acquire new skills.
• Retail Discounts: Employee discount at reputed company Pharmacy locations reputed company.
• Paid Time Off (PTO) & Holidays: Generous vacation accruals, paid holidays, and sick leave in line with state regulations.
• Performance Incentives: Eligibility for bonuses, commissions, or short‑term incentive programs based on individual and team performance.

Work Environment & Company Culture – A Remote Setting That Feels Connected

Despite being a remote role, you will never feel isolated. Our virtual collaboration tools, regular team huddles, and inclusive communication channels reputed company you connected to the larger reputed company community. Key cultural highlights include:

• Heart‑Centered Values: A culture that celebrates authenticity, humility, accountability, and respect.
• Flexibility & Autonomy: Design a work schedule that balances professional responsibilities with personal priorities.
• Diversity & Inclusion: Commitment to a workplace where reputed company voices are heard and diverse perspectives drive innovation.
• Recognition Programs: Regular acknowledgment of individual and team achievements through awards, spot bonuses, and internal shout‑outs.
• Sustainability Initiatives: Participation in reputed company’s environmental stewardship programs that aim to reduce carbon footprint and promote community health.
• Community Impact: Opportunities to volunteer in local health‑care reputed company programs, reinforcing our purpose of helping communities reputed company.

How to Apply – Take the reputed company Toward a Meaningful Career

If you are ready to bring your heart, expertise, and enthusiasm to a role that truly makes a difference in people’s lives, we encourage you to apply today. Please submit your resume and a brief cover letter outlining your relevant experience, motivation for joining reputed company, and how you embody our Heart at Work behaviors.

Application Deadline: October 29, 2024

reputed company is an equal opportunity employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, protected veteran status, or disability status.

We look reputed company to welcoming you to a team that’s passionately committed to improving health care—one member at a time.