Where Compassion Meets Innovation and Technology Thank you for your interest in joining our team! Please review the job information below.$3,500 Sign-on Bonus Offered! General Purpose Of JobThe Customer Service Representative is responsible for assisting members and providers with healthcare inquiries, 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 as assigned 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: abuse, neglect and exploitation, authorizations, behavioral health, claims, complaints, crisis calls, eligibility, health insurance benefits, locating providers, pharmacy benefits, transportation, waste abuse and fraud.90% 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 equivalent.
- Customer service experience.
- Experience working in a call center or healthcare related field is a plus.
- Strong customer service skills, including courteous telephone etiquette and professionalism.
- Prior understanding and awareness of call center metrics and goals preferred.
- Prior healthcare experience, in particular, Medicaid Insurance Plans preferred.
- Ability to type a minimum of 35 words per minute.
- Knowledge of managed care processes and health insurance coverage preferred.
- Knowledge of medical terminology preferred.
- Outstanding communication skills and the ability to understand complex situations to effectively handle escalated customer needs.
- Analytical skills and the ability to read and interpret data.
- Problem solving abilities.
- Ability to work independently and as a part of a team.
- Ability to operate computer programs – Proficiency with Microsoft Office applications, particularly Outlook, Word, and MS Teams.
