Call Center Customer Service Representative

20 Driscoll Children's Health Plan; United States; On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Sign-On Bonus

Job summary

Driscoll Health Plan is seeking a Call Center Customer Service Representative to assist members and providers with questions about Medicaid benefits, eligibility, claims, and authorizations. This onsite role requires excellent communication, patience, and problem-solving abilities in a fast-paced environment.

The position supports scheduling, account navigation, and access to health plan resources. A high school diploma and 6 months in a call center or healthcare setting are required, with a 35

Qualifications

• Respond to member/provider inquiries via phone in a timely, professional manner.
• Document interactions and research information across systems with accuracy.
• Navigate multiple applications to resolve questions on benefits, eligibility, and claims.
• Maintain HIPAA compliance and confidentiality in all interactions.
• Type with speed and accuracy to support call handling expectations.
• Demonstrate problem-solving to resolve issues on first contact when possible.

Responsibilities

• Meet established call center performance expectations, including spending ~90% of scheduled time handling phone calls.
• Answer incoming calls from members and providers professionally and promptly.
• Assist callers with Medicaid benefits, eligibility, claims, authorizations, and other services.
• Provide accurate information and resolve inquiries on the first call when possible.
• Navigate computer systems to research, document, and resolve customer inquiries.
• Maintain detailed documentation of calls, inquiries, and resolutions.
• Assist members with locating providers, scheduling appointments, and navigating the portal.
• Handle sensitive situations with patience, professionalism, and empathy.
• Collaborate with internal departments to expedite concerns when needed.
• Maintain confidentiality and HIPAA compliance.

Skills

Customer service

Phone etiquette

Verbal communication

Written communication

Typing speed 35 wpm

Attention to detail

Multitasking

Empathy

Education

High school diploma or equivalent

Tools

Outlook

Word

Teams

Job description

Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below.

Call Center Customer Service Representative - $3,500 Sign-On Bonus Offered!

Work Schedule: Monday–Friday, 8:00am–4:30pm or 8:30am–5:00pm | Onsite

Join the Driscoll Health Plan Call Center team! The Driscoll Health Plan is a Medicaid Managed Care organization dedicated to helping members access the healthcare services and resources they need. We are seeking a friendly, dependable, and detail-oriented Call Center Customer Service Representative to assist our members and healthcare providers with questions regarding health insurance benefits, eligibility, claims, authorizations, crises calls, abuse, fraud, and other healthcare-related needs. This is a fast-paced, phone-based position that requires excellent communication skills, patience, problem-solving abilities, and a commitment to providing exceptional customer service.

Key Responsibilities

• Meet established call center performance expectations, including spending approximately 90% of scheduled time handling phone calls, based on business needs.
• Answer incoming calls from Driscoll Health Plan members and healthcare providers in a professional, courteous, and timely manner.
• Assist callers with questions regarding Medicaid benefits, eligibility, claims, authorizations, pharmacy benefits, transportation, provider information, and other healthcare services.
• Provide accurate information and work toward resolving questions or concerns during the first call whenever possible.
• Navigate multiple computer systems to research information, document interactions, and resolve customer inquiries.
• Maintain accurate and detailed documentation of calls, inquiries, and resolutions.
• Assist members with locating healthcare providers, scheduling appointments, and navigating the Driscoll Health Plan website.
• Handle sensitive or complex situations with patience, professionalism, and empathy.
• Collaborate with internal departments to resolve issues and expedite concerns when necessary.
• Maintain confidentiality and comply with HIPAA regulations, organizational policies, and regulatory requirements.

Qualifications & Skills

• High school diploma or equivalent required.
• Minimum of 6 months of experience in a call center or healthcare-related field required.
• Strong customer service skills with excellent telephone etiquette and professionalism.
• Excellent verbal and written communication skills.
• Ability to type at least 35 words per minute.
• Strong attention to detail, organizational skills, and problem-solving abilities.
• Ability to multitask and navigate multiple computer applications while assisting callers.
• Comfortable working in a fast-paced, high-volume call center environment.
• Proficiency in Microsoft Office applications, including Outlook, Word, and Teams.
• Previous experience with Medicaid, health insurance, managed care, or medical terminology preferred.
• Familiarity with call center performance metrics and goals preferred.

Until all children are well.

Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success.

Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies.

The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes.

We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.