Precertification Specialist I (Customer Service Specialist))

Innovative Care Management, Inc. is hiring a Precertification Specialist I (Customer Service Specialist) to serve as a primary telephone contact for callers seeking assistance with precertification services. The role provides status information, routes requests and questions to the appropriate teams, documents interactions, and supports callers with professionalism and empathy.

Responsibilities:

• Answer a high volume of inbound calls from physician offices, hospitals, patients, and other callers with professionalism, empathy, and excellent customer service
• Remain available in assigned phone and voicemail queues throughout scheduled working hours, excluding approved breaks, meal periods, and other authorized activities
• Listen actively, clarify the purpose of each call, and provide accurate information within established precertification procedures and the scope of the role
• Communicate precertification status information and approval numbers when available and approved for release
• Verify precertification requirements and identify requests that need additional processing or entry by another team member
• Route incoming calls, callback requests, messages, and precertification-related needs promptly to the appropriate team or resource
• Refer benefit-related inquiries to the appropriate claims administrator or benefits department
• Transfer or escalate clinical, complex, unusual, or out-of-scope questions appropriately
• Handle difficult or sensitive conversations calmly and professionally while providing clear guidance on next steps
• Accurately document call details, messages, actions taken, and follow-up needs in approved systems
• Communicate relevant caller information clearly and promptly to teammates to help prevent missed follow-up or service delays
• Maintain objective, complete, and factual documentation without including assumptions, personal opinions, or subjective interpretations
• Follow established expectations for call handling, quality, availability, productivity, and escalation
• Maintain the privacy and security of patient and member information in accordance with HIPAA and company policies
• Follow approved verification and communication procedures before releasing protected or sensitive information
• Complete assigned outbound calls and other telephone-based customer service responsibilities as needed

Requirements:

• At least one year of experience in a call center, contact center, or other telephone-based customer service role
• Strong communication and active-listening skills, with the ability to remain patient, professional, and empathetic during challenging conversations
• Comfort handling a steady volume of calls while navigating multiple computer systems and documenting information accurately
• Strong attention to detail and the ability to follow established processes and procedures
• Good judgment and the ability to recognize when a question should be referred or escalated
• Dependability, punctuality, and the ability to work independently in a remote environment while remaining available during scheduled hours
• Comfort learning new technology, systems, and workflows
• Strong problem-solving skills and a willingness to ask questions, learn, and respond to feedback
• The ability to handle confidential information appropriately and protect patient and member privacy
• A high school diploma or GED
• Healthcare experience is helpful, but not required
• Experience in a medical office, health insurance, third-party administrator, patient services, or healthcare call center environment would be a plus
• Familiarity with medical terminology, prior authorization or precertification processes, call queue systems, or remote customer service is also helpful
• Bilingual communication skills are a plus