Call Center Representative

9 hours ago


Bellaire, United States Pride Health Full time

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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