Reports directly to the Medical Referral Manager, responsible for providing warm and pleasant customer service in assisting members regarding issues and concerns such as but not limited to off-island authorization, eligibility, benefit administration, claims, billing, reimbursements, medical records, etc. and provides clerical and administrative support to functions related to the Medical Referral Office processes. DUTIES AND RESPONSIBILITIES MAY INCLUDE BUT NOT LIMITED TO: Greets and assists walk-in members. Handles and documents check-in of walk-in members on log-sheet. Helps/assists walk-in members to connect with the right department and/or Individual. Provides customer support throughout the care coordination including but not limited to any of the following concerns: Eligibility, Benefit Administration, Referrals, Appointments, Claims, Billing, Reimbursements, Plan Deductible, Referrals (status & process), Insurance Coverage, Coordination of Benefits Services available, Network Providers/Access, Medical Records Computes and explains member’s financial responsibility by reviewing statements of account. Collects updated Membership information from walk-in members. Updates and maintain member walk-in, phone, and email inquiry demographics on a Monthly basis. Answers incoming calls and directs them accordingly. Forwards inquiries to appropriate staff or departments (e.g. other Medical Referral Office staff, Medical Management, Claims, etc. Collaborates with Customer Service staff for customer service-related issues. Forwards and endorses walk-in members to assigned Customer Service Associate Regarding claims, reimbursements, deductibles, appeals, grievances and billing inquires. Updates and organizes member files. Provides administrative support to Medical Referral Manager. Performs other duties that may be assigned from time to time. JOB SPECIFICATIONS: 1. Graduate of Nursing – license not required 2. Minimum of 1 year experience in providing warm and pleasant customer service in assisting walk-in members regarding issues and concerns such as but not limited to eligibility, benefit administration, claims, billing reimbursements and etc. 3. Effective team player. With very good interpersonal relationship skills and can work and relate well with co-employees, patients and customers. 4. Must have the behavioral sensitivity, maturity, diplomacy and tact in addressing complex situations and handling irate customers. 5. Outstanding oral and written communication skills. 6. Strong ethics and a high level of personal and professional integrity. 7. Must have basic familiarity on laws and requirements relating to healthcare management.