Precertification Specialist I (Customer Service Specialist))

Innovative Care Management, Inc. provides healthcare support services to members and health plans. The Precertification Specialist I serves as a primary telephone contact for precertification inquiries, providing status information, routing questions and requests, and documenting calls and follow-up needs.

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:

• Candidates must reside in Oregon
• 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