Senior Call Center Representative - Member Services

Texas Children's Hospital; Bellaire (TX); On-site; USD 42,000 - 56,000; Full time

Job summary

Texas Children's Health Plan is seeking a Senior Call Center Representative— someone who thrives in a fast-paced environment. The role involves acting as a member/provider advocate, handling eligibility, benefits, authorizations, claims, referrals, and scheduling while guiding inquiries to appropriate resources.

You will support members and providers through the complaint and appeal process, ensuring timely assistance and upholding HIPAA and privacy standards in all interactions.

Qualifications

• High school diploma or GED required.
• Experience in customer service and call centers in managed care or insurance preferred.
• Bachelor's degree can substitute for two years of experience.

Responsibilities

• Act as a secondary resource for call center reps and respond to escalated calls.
• Identify and handle routine to complex inquiries from members/providers.
• Educate members about health coverage benefits and available resources.
• Meet performance goals for customer satisfaction, quality, and productivity.
• Ensure HIPAA and privacy regulations are followed at all times.
• File complaints and appeals within regulatory timelines and policies.

Education

High school diploma or GED

Bachelor's degree may substitute for two years of experience

Job description

Job Description We are searching for a Senior Call Center Representative— someone who works well in a fast-paced setting. In this position, you will serve as a member and/or provider advocate that understands the organization's processes, policies, and procedures to investigate, resolve and/or facilitate the resolution of simple to complex issues/questions. You will be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other member/provider demands. Lastly, you will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling.

Job Description We are searching for a Senior Call Center Representative— someone who works well in a fast-paced setting. In this position, you will serve as a member and/or provider advocate that understands the organization's processes, policies, and procedures to investigate, resolve and/or facilitate the resolution of simple to complex issues/questions. You will be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other member/provider demands. Lastly, you will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling.

Think you’ve got what it takes?

Job Duties & Responsibilities

• Act as a secondary resource to Call Center Representatives in the absence of the Team Lead and responds to escalated calls and triages to management, if necessary
• Identify and handle a variety of routine to complex customer or prospect inquiries or requests
• Educate members about their health coverage benefits and services and empowering members/providers by directing them toward available resources for self-help
• Meet Senior Member Service Representative performance goals for customer satisfaction, quality, productivity, and all performance metrics
• Ensure all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times
• File complaints and appeals on behalf of members and providers within the regulatory timeframe and in compliance with departmental policies and procedures

Skills & Requirements

• High school diploma or GED
• Minimum of 3 years of customer service, call center, and/or experience within managed care or insurance industry or
• A Bachelor's degree may substitute for two (2) years of the required experience

About Us

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children\'s Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.