HP Customer Serv Rep Non Bil

About the Role

The Customer Service Representative is responsible for assisting members and providers with healthcare inquiries, concerns, or complaints via telephone.

Key Responsibilities

• Assist members and providers by responding to telephone inquiries promptly, accurately, and objectively regarding:
• Abuse, Neglect and Exploitation
• Authorizations
• Behavioral Health
• Claims
• Complaints
• Crisis Calls
• Eligibility
• Health Insurance Benefits
• Locating providers
• Pharmacy Benefits
• Transportation
• Waste Abuse and Fraud
• Spend approximately 90% of scheduled time on the phone, according to business needs.
• Drive resolution of caller questions/issues on the first call whenever possible and ensure proper documentation of calls and resolution actions.
• Understand and adhere to HIPAA requirements.
• Adhere to Regulatory Guidelines and policies & procedures.
• Navigate through complex computer systems to identify the status of the issue and provide appropriate response to the 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 problems 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.

Qualifications

• Minimum of a high school diploma or equivalent.
• Customer service experience.
• Strong customer service skills, including courteous telephone etiquette and professionalism.
• Ability to type a minimum of 35 words per minute.
• 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 part of a team.
• Ability to operate computer programs – Proficiency with Microsoft Office applications, particularly Outlook, Word, and MS Teams.

Preferred Qualifications

• Experience working in a call center or healthcare related field.
• Prior understanding and awareness of call center metrics and goals.
• Prior healthcare experience, in particular, Medicaid Insurance Plans.
• Knowledge of managed care processes and health insurance coverage.
• Knowledge of medical terminology.