HP Customer Serv Rep Non Bil

Driscoll-Children; Corpus Christi (TX); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Sign-on bonus $3,500

Job summary

Driscoll Health Plan seeks a Customer Service Representative to assist members and providers with healthcare inquiries, concerns, or complaints by telephone.

Role requires handling calls, documenting interactions, and resolving issues with empathy and accuracy. A high school diploma is required; Medicaid/health plan experience is a plus, along with strong communication and 35 WPM typing skills.

Qualifications

• Minimum of a high school diploma or equivalent.
• Customer service experience
• Experience in a call center or healthcare field is a plus
• Strong customer service skills and professional telephone etiquette
• Knowledge of Microsoft Office applications (Outlook, Word, MS Teams) preferred
• Typing speed of 35 words per minute or more
• Knowledge of managed care processes and health insurance coverage preferred
• Knowledge of medical terminology preferred
• Excellent communication and problem-solving abilities
• Ability to work independently and in a team

Responsibilities

• Assist members and providers by responding to telephone inquiries regarding health plans, benefits, claims, and related topics.
• Drive resolution of questions on the first call when possible and document actions taken.
• Adhere to HIPAA requirements and regulatory guidelines.
• Navigate multiple computer systems to determine issue status and respond appropriately.
• Read, comprehend, and verbalize processes and procedures.
• Multi-task using several software applications and maintain attention to detail.
• Escalate root-cause issues to supervisors as needed and collaborate with other departments.
• Own problems through to resolution and follow-up with members or providers.

Skills

Customer service

Call center experience

HIPAA compliance

Medical terminology

Microsoft Office

Typing 35 wpm

Education

High school diploma

Tools

Outlook

Word

MS 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.$3,500 Sign-on Bonus Offered!GENERAL PURPOSE OF JOB:The Customer Service Representative is responsible for the assisting Member/ Provider with healthcare inquires concerns, or complaints via telephone.ESSENTIAL DUTIES AND RESPONSIBILITIES: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 accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties asassigned by the immediate supervisor and/or health plan administration, as required.General Duties:Assist members and providers by responding to telephone inquiries in a prompt, accurate and objective manner regarding but not limited to:o Abuse, Neglect and Exploitationo Authorizationso Behavioral Healtho Claimso Complaintso Crisis Callso Eligibilityo Health Insurance Benefitso Locating providerso Pharmacy Benefitso Transportationo Waste Abuse and Fraud90% of the scheduled time on the phone according to business needs.Drives resolution of caller questions/issues on the first call whenever possible and ensures proper documentation of calls and resolution actions.Understand and adhere to HIPAA requirements.Adhere to Regulatory Guidelines and policies & procedures.Navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller.Review previous call interactions/notes.Communicate monthly messages to members and providers on a specific need basis.Deal tactfully and empathetically with members and providers.Establish and maintain effective working relationships with provider office staff.Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.Multi-task by utilizing multiple complex computer applications.Pay close attention to detail.Identify issues/trends and escalate to Supervisor / Manager when assistance is needed.Develop relationships with other departments to provide feedback about root cause issues.Intervene with providers on behalf of the customer to assist with appointment scheduling or connections with specialists for assistance when needed.Assist customers in navigating through the Driscoll Health Plan website and encourage and reassure them to become self-sufficient.Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member and or provider.Research complex issues across multiple databases and work with internal departments to resolve customer issues and/or partner with others to resolve escalated issues.Other duties as assigned.EDUCATION AND/OR EXPERIENCE:Minimum of a high school diploma or equivalentCustomer service experienceExperience working in a call center or healthcare related field is a plusStrong customer service skills, including courteous telephone etiquette and professionalismPrior understanding and awareness of call center metrics and goals preferredPrior healthcare experience, in particular, Medicaid Insurance Plans preferredAbility to type a minimum of 35 words per minuteKnowledge of managed care processes and health insurance coverage preferredKnowledge of medical terminology preferredOutstanding communication skills and the ability to understand complex situations to effectively handle escalated customer needsAnalytical skills and the ability to read and interpret dataProblem solving abilitiesAbility to work independently and as a part of a teamAbility to operate computer programs – Proficiency with Microsoft Office applications, particularly Outlook, Word, and MS Teams