Call Center Representative
9 hours ago
Job Title - Call Center Representative
Location - Houston, TX 77401
Duration -3 + months
Shift- 9 am-5:30 pm
Pay Range- $18.00/hr- $20.00/hr
Note - 9 am-530pm-Training will be onsite and once cleared the position in Remote contingent upon performance
Job Duties
- Serve as a Member and/or Provider Advocate by understanding the organization’s processes, policies, and procedures.
- Investigate, resolve, and facilitate the resolution of simple to moderately complex issues reported by TCHP members, prospective members, healthcare providers, or other entities.
- Act as the first point of contact for inquiries related to eligibility, benefits, authorizations, claims, referrals, and other Member/Provider needs.
- Assist and advocate for Members and/or Providers throughout the complaint and appeal process.
- Assist Members with timely appointment scheduling.
- Handle calls from Members/Providers seeking assistance with related issues.
- Review systems to identify issues, research thoroughly, collaborate with departments, communicate with internal and external resources, and provide appropriate responses.
- Act as a liaison and advocate for Members/Providers.
- Gather information to support decisions or recommendations for action needed to resolve issues or concerns.
- Assist with real-time resource management.
- Interact tactfully and empathetically with Members/Providers.
- Ensure HIPAA compliance by verifying the identity of all callers before disclosing Personal Health Information (PHI).
- Complete all assigned work queue tasks and after-hour call center vendor notifications.
- Accurately document information in TCHP or TCH systems (e.g., MACESS or EPIC).
- Alert team leader of any issues or concerns requiring escalation or indicating larger problems.
Skills:
- Knowledge of managed care, customer service, call center desktop support applications, and general computer literacy.
- Ability to work well with the public and adopt a customer-focused perspective, both independently and in a team environment.
- Effective interpersonal skills and phone etiquette.
- Strong verbal communication skills and good listening ability.
- Knowledge of medical terminology.
- Problem identification, problem-solving skills, and the ability to multitask.
- Typing speed of 35 WPM.
- Bilingual (English-Spanish) preferred.
- 1 year of customer service experience within the managed care or insurance industry, or call center experience in any industry.
Education:
- High School Diploma or GED
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