The Case Coordinator provides active case management by directing to in network facilities, initiating and managing ongoing communication with health care providers and hospitals.
**Expected Outcomes & Actions - Weighting**
Communication 50%
a. Verbal and written communication with hospital to secure medical assessment for customers
b. Obtain authorization from Canadian Case Management for proposed treatment and relay authorization accurately and promptly.
d. Be available to handle incoming calls via telephony system
a. Expected to handle communication and continued management of cases assigned to other coordinators on days off or on other calls
e. Document relevant case updates/translate communication with external parties in English.
f. Communicate with facilities and care providers for client updates and plans
g. Communicate with specialized vendors to coordinate lateral transfers
Case Coordination 50%
a. Review new case assignments promptly
b. Continuous reassessment of priority of case risk and work
c. Obtain medical release and other documents required for claim coordination and adjudication are obtained from the facility
d. Work closely with the Medical team, LATAM negotiators, Canadian Case Coordinators/Managers, and other GEM departments when applicable
e. Coordinate direct billing and place guarantees of payment up to authority threshold
f. Ensure documents/information required to make a financial commitment are obtained
g. Obtain cost estimates for treatment or continued admission.
**Major Challenges**
- Shift Work, including weekends and holidays
- Working with multiple systems;
- Frequent interruptions
- Collaborating with team members across multiple regions
- Understanding role and scope of work
- Being available to handling incoming calls while working on active claims that require attention
- Staying current on processes and products;
- Remaining calm and professional in difficult situations.
**Major Job Accountabilities**
- Clean Claim - Obtain all information to support adjudication/payment of the claim
- Accuracy - providing accurate information to internal team members and facilities/health care providers.
- Quality - providing professional service as per the quality guidelines;
**Success Measures**
- Responsible to support the Case Management SLA;
- Meeting or exceeding your quality targets;
- Meeting or exceeding your productivity targets;
- Meeting or exceeding your adherence targets.
**KSA (Knowledge, Skills, and Abilities/Attitudes)**
- Professional
- Excellent communicate skills
- Excellent customer service skills
- Good computer skills
- Team player
- Reliable
- Ownership
- Attention to detail
- Balanced Decision Making
- Empathetic Outlook
- Flexibility
- Problem solving skills
- Positive attitude
- Stress management skills
- Personal accountability
- Result oriented
- Self-confidence
- Understanding the corporate client culture/expectations
- Multi-tasking
**Requirements and Qualifications**
- College Diploma or equivalent combined with experience in customer service, telecommunication, assistance and claims, or medical field is an asset (ex. Nursing).
- Clear and effective communication in English and Spanish (written and verbal)
- Capacity to work with people in a fast-paced, team-based environment.
- Must exhibit strong communication skills and professionalism.
- Capable and confident in negotiations and problems solving skills.
Tipo de puesto: Tiempo completo, Por tiempo indeterminado
Sueldo: $15,000.00 - $16,000.00 al mes
Beneficios:
- Seguro de gastos médicos mayores
- Seguro de vida
- Vales de despensa
Pago complementario:
- Bono anual
Tipo de jornada:
- Turno de 8 horas
Lugar de trabajo: remoto híbrido en 03200, Ciudad de México, CDMX