Customer Solutions Expert I - UM Admin

Job ID


Identify the need(s) of the referring source and/or patient by collecting all necessary data relevant to that need; interpret, verify and process that data to determine if patient is eligible; and facilitate the initiation and termination of the care and services provided in a timely manner. Respond to customer issues that may arise during and after order processing. Actively engages and coordinates with other team members to maintain a positive, collaborative relationship. Works under close supervision.




• Works closely with health plans/payers and maintains strong business relationships.
• Provides appropriate issue resolution and/or escalation when needed. Works under moderate supervision, with clinical oversight.
• Reviews and adheres to all Company policies and procedures and the Employee Handbook.
• Participates in special projects and performs other duties as assigned.
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
• Participates in and contributes to performance improvement activities.


• Tracks cases that are recommended for denial through all clinical bins
• Maintains the data to high quality standards.
• Utilizes a systematic tool to perform a one to one match in reviewing for medical necessity
• Tracks cases within the CareCentrix workflow management system to assure cases are being processed in accordance with required turnaround times.
• Ensure that letters are generated and mailed within required timeframes.
• Works with several departments, including but not limited to, operations, clinical, quality and the correspondence team to assure accuracy and timeliness processing from end to end.
• Works with Clinical Team to prepare forms and other necessary documentation for delivery to MD offices and external providers.
• Provides issue resolution and escalation to management when appropriate.


• High School Diploma or the equivalent required. Associates or Bachelor’s degree preferred.
• One year billing, insurance or claims experience preferred.
• The ability to effectively multi-task.
• Medical terminology, insurance verification or healthcare experience preferred.
• Must be proficient and comfortable in a computer-based environment.
• Embraces the values of accountability, consistency, engagement, patient compassion, empowerment, respect and outstanding service.
• This position requires excellent communication, customer service and problem solving skills, as well as the ability to effectively interact with all levels of management and highly diverse customers.
• Must have strong organizational skills and be extremely detail-oriented.
• Demonstrates critical thinking and has the ability to analyze data to understand an expected outcome, Must be able to effectively manage and prioritize tasks and thrive in a fast-paced environment.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill and/or ability required.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• Masters the Intake/Verifications function as well as a second function; Staffing as back-up and learns two health plans.


CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.


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