Customer Service Representative

Customer SupportCustomer SupportFull TimeRemoteTeam 501-1,000Since 2013H1B No SponsorCompany Site LinkedIn

Location

Nevada

Posted

124 days ago

Salary

$41.7K - $62.5K / year

High School1 yr expEnglish

Job Description

• Provides in-market, specialized member support in respective market or region • Conducts in-market member engagement including Welcome Calls, New Member Onboarding, JSA Scheduling, High Quality PCP and Provider Terms, Product/Vendor Changes, CAHPS Proxy, Disenrollment Quality Assurance, and Proactive Service Recovery • Conducts case follow-ups and quality member issue resolution for all cases assigned • Ensures members have access to PCP and specialists to coordinate care • Educates members on gaps in care and assists with scheduling provider appointments • Serves as the patient's liaison throughout the life cycle of the program by addressing program specific quality measures and adhering to company guidelines/standard operating procedures • Makes appropriate and timely patient appointments, reminders, and confirmations • Mails letters and correspondence as needed • Places regular/consistent outreaches to the patient • Communicates with PCP with any member updates and requests • Assists with obtaining medical records from any healthcare providers involved in care or hospitals • Helps members with any authorizations and referrals involved in their care plan • Resolves incoming calls concerning members’ eligibility, benefits, provider information, clinical, and pharmacy needs; coordinate membership changes such as member’s primary care physician and proactively engage member with their wellness plan options • Participates in on-site member engagement activities as needed, such as in-person member meetings, handling lobby calls at a retail or care center location, etc. (subject to change).

Job Requirements

Minimum 1 year of customer service experience
High-volume inbound customer service experience, particularly for health plan or Medicare ‘Member Services’ roles preferred
Telemarketing and/or member outreach experience preferred
Specialized experience in escalation or resolution units preferred
High School Diploma or GED required
Knowledge of ICD-10 and CPT codes required
Keyboard typing 40+ words per minute required
Ability to help members navigate access to care through Medicare Advantage or HMO, including referrals and authorizations required
Ability to communicate positively, professionally and effectively with others required
Effective written and oral communication skills required
Ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors required
Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals required
Ability to write routine reports and correspondence required
Ability to speak effectively before groups of customers or employees of the organization required
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions required
Ability to deal with problems involving a few concrete variables in standardized situations required
Ability to perform mathematical calculations and calculate simple statistics correctly required
Effective problem solving, organizational and time management skills preferred
Ability to work in a fast-paced environment required
Bilingual English/Spanish or English/Vietnamese or English/Mandarin preferred
Fluency in written and verbal Spanish, Korean, or Vietnamese a plus.