TeleMedik

Customer Support

• Communicates with members by phone to provide information about their respective health insurance plan services.
• Offers guidance, support, and educational services on non-clinical matters related to the different plan coverages and promotions.
• Manages incoming calls and refers them to the appropriate resources based on the member’s specific needs.
• Documents and records transactions, including details of inquiries and actions taken.
• Refers unresolved customer complaints to a supervisor or designated departments for further investigation.
• Supports other Contact Center projects.
• Conducts outbound phone interviews with members regarding services, satisfaction levels, and follow-up activities.
• Participates in training and development sessions.
• Ensures confidentiality and compliance with all applicable state and federal health call center regulations, including HIPAA and internal policies for handling confidential information.
• Immediately reports any Protected Health Information (PHI) exposure to the supervisor.
• Complies with core and functional trainings, as well as all procedures established by regulatory agencies, contractual requirements, and applicable certification standards (including but not limited to URAC).

Customer Service Representative

Bilingual

• Communicates with members by phone to provide information regarding services covered by their respective health insurance plan.
• Provides guidance, support, and educational services on non-clinical matters related to different plan coverages and promotions.
• Manages incoming calls and refers them to appropriate resources based on the member’s specific needs.
• Documents and records transactions, including details of inquiries and actions taken.
• Refers unresolved customer complaints to a supervisor or designated departments for further investigation.
• Provides support in other Contact Center projects.
• Conducts outbound calls to members to gather information about services, satisfaction levels, and follow-up activities.
• Participates in training and development sessions.
• Ensures confidentiality and compliance with all applicable state and federal health call center regulations, including HIPAA and internal policies for the disposal of confidential information.

Bilingual CSR

IT Support

• The Help Desk Technician provides technical assistance to computer system users via face-to-face interventions, telephone, or remotely
• Provides onsite or remote support for computer systems including end-user computers/peripherals, servers, LAN, WAN, and WLAN
• Performs PC installation, relocation, upgrades, preventive maintenance, repair activities and user account maintenance via internal help desk system
• Analyzes daily backups to ensure system availability and continuity and manages a comprehensive tape backup system
• Performs ongoing PC management through proactive application of software patches, migrating users to new software releases, and repair or rebuild of end-user PC’s
• Interfaces with users to determine, acquire and setup suitable hardware/software requirements and troubleshoot and resolve user hardware/software issues
• Develops and maintains operational and procedural documentation
• Assesses and recommends new hardware and software purchases to IT management
• Performs quarterly user PC audits to ensure compliance with company policies
• Maintains company-wide inventory of computer hardware/software, network equipment, and end user software
• Maintains company-wide network diagram
• Provide on-call support during Help Desk out-of-office hours and escalate unresolved issues to appropriate team members
• Participate in ad hoc projects as deemed necessary by the System Administrator
• Ensure confidentiality and compliance with all state and federal regulations applicable to Health Call Centers, including HIPAA and internal policy for disposing of confidential information material
• Inventory Notify any expose of Protected Health Information to the supervisor immediately

Help Desk Technician

• Guide providers and insured members regarding medication rejections, prior authorizations, duplicate therapies, among other matters
• Receive calls from community pharmacies for medication authorization requests
• Process medication authorization requests according to the health care insurer’s authorized lists
• Consult the Pharmacist regarding medication authorization requests, if necessary
• Use computer systems according to the received calls (e.g., Facets, PICA, Caremark, WHI, etc.)
• Receive prescriptions via fax, forward them to the health care insurer, and deliver a copy to the supervisor
• Document received calls including the caller’s name, time, member contract number, drug name, and call process
• Ensure confidentiality and compliance with all applicable state and federal regulations for Health Call Centers, including HIPAA and internal policies
• Immediately notify the supervisor of any exposure to Protected Health Information
• Comply with core trainings and all procedures established by regulatory agencies and contractual requirements

Customer Service Representative

Bilingual CSR

Help Desk Technician

Bilingual Pharmacy Technician