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- 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.
