Handle calls in a clinical operations support environment, resolving member and provide queries efficiently.
Provide guidance on appropriate levels of care (primary care, urgent care, emergency services, telemedicine) based on caller needs and defined protocols.
Assess caller situations and identify potential urgent or emergency cases, ensuring timely escalation to clinical teams when required.
Deliver professional, calm, and empathetic customer support during all interactions, especially in high-stress or sensitive situations.
Support a blended process (voice and non-voice) by managing calls, documenting cases, and responding to queries across multiple channels.
Accurately document call details, medical concerns, and resolutions using appropriate systems and tools.
Utilize foundational medical terminology to understand, capture, and communicate patient/member concerns effectively.
Follow standardized scripts and workflows to guide callers, including directing them...