Managing incoming calls or incoming post services claims work. Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. Obtains intake (demographic) information from caller. Conducts a thorough radius search in Provider Finder and follows up with provider on referrals given. Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization. Verifies benefits and/or eligibility information. May act as liaison between Medical Management and internal departments. Responds to telephone and written inquiries from clients, providers and in-house departments. Conducts clinical screening process. Minimum Qualifications: Requires HS diploma or equivalent and a minimum of 2 years’ customer service experience in healthcare-related setting and medical terminology training; or any combination of education and experience which would provide an equivalent background. Certain contracts require a Master's degree. Preferred Skills, Capabilities and Experiences: Experience working in health insurance or with a managed care organization is preferred. Prior knowledge in infusion pharmacy or benefit investigation is strongly preferred. Ability to self-start, be coachable and flexible is strongly preferred. Prior experience with navigating multiple systems, partners, and internal & external customers is strongly preferred. Experience working with the CPR platform or Care. Tend platform is a plus. Candidates in alternate locations are welcome to apply provided they reside within commuting distance of a Pulse Point office location. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Job Level:Non-Management Non-Exempt. Workshift: