Vacancy expired!
ESSENTIAL FUNCTIONS Responsible for inbound phone inquiries primarily dealing with either:
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- Member benefits and eligibility related to the Medicaid, CHP and FHP product lines or
- Provider benefits, eligibility, PEP and claim status, member pharmacy calls, utilizing prior approval skills (ACP/DME and CCD) and placing outbound calls on a routine basis.
- Resolve issues with respect to benefits and eligibility by researching documentation, system information or gaining knowledge from other employees, management or departments.
- Interact with customers, document call specifics and demonstrate quality program behaviors to create an outstanding relationship with each caller.
- Work with outside vendors as needed to answer questions or resolve issues.
- Respond to member correspondence/email in writing utilizing an existing Customer Service system letter to effectively respond to members.
- Conduct orientation to new members by providing an overview of the member's plan and pertaining administrative policy.
- SECONDARY RESPONSIBILITIES
- Demonstrate awareness, motivation, and technical skills to assist in the development and growth of the customer service teams and help to identify process improvements.
- Assist in department/company projects, as needed, i.e. provide feedback about the customer's experience.
- High School Diploma, GED, or Equivalent work experience
- Must be computer literate and able to multi-task i.e. document call experience while using the Quality Program.
- Excellent communication and interpersonal skills.
- Bilingual fluency in English and Spanish
- Healthcare/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design)
- Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)
- Sales or account management experience
- Customer Service Experience
Vacancy expired!