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 to telemedicine services or emergency care when necessary.
Handle after-hours interactions by taking detailed messages and coordinating follow-ups with clinical teams within defined timelines.
Coordinate with nurses, clinicians, and internal teams to ensure seamless case resolution and continuity of care.
Maintain data accuracy and perform administrative tasks such as updating records, managing case logs, and supporting clinical operations processes.
Ensure adherence to compliance requirements, confidentiality standards, and healthcare regulations while handling sensitive information.
Continuously improve enhanced knowledge of healthcare processes, clinical workflows, and customer service practices to improve support delivery.
