Travel Technician in Bellaire, TX

2 weeks ago

Bellaire, United States Cynet Health Full time
**Job Title:** Senior Call Center Representative
**Job Specialty:** Member Services - Inbound, Health Plan
**Job Duration:** 14 months
**Shift:** Remote - Must be local in the event there is a need to come into the office
**Guaranteed Hours:** 40 hours per week
**Experience:** Minimum of 3 years in customer service within managed care or insurance industry, or call center experience in any industry
**License:** N/A
**Certifications:** N/A
**Must-Have:** High school diploma or GED, member service experience, bilingual preferred (English/Spanish)

**Job Description:**

- Serve as a Member and Provider Advocate by understanding organizational processes, policies, and procedures.
- Investigate, resolve, and facilitate resolution of simple to moderately complex issues or questions reported by health plan members, prospective members, healthcare providers, or other entities.
- Be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals, and other Member/Provider needs.
- Assist and advocate for Members and Providers throughout the complaint and appeal process.
- Assist Members with timely appointment scheduling.
- Verify member eligibility and support Call Center Representatives as needed.
- Act as a secondary resource to Call Center Representatives in the absence of the Team Lead.
- Respond to escalated calls and triage to Management if necessary.
- Assist with processing workflow queues to ensure timely submittal as requested by the Team Lead.
- Help onboard new hire employees in a Nesting environment, providing job shadowing and mentorship.
- Complete and manage Pharmacy queue and Right Fax.
- Assist members/providers with billing inquiries and resolve billing issues.

**Skills Required:**

- Knowledge of managed care, Medicaid, call center desktop support applications, customer relations techniques, and general computer literacy.
- Benefits, claims processing, or membership knowledge preferred.
- Ability to work well with the public, adopt a customer perspective, and excel individually and in a team environment.
- Effective interpersonal skills and phone etiquette.
- Strong verbal communication and good listening skills.
- Knowledge of medical terminology.
- Problem identification and solving skills, with the ability to multitask.
- Typing skills, 35 WPM.
- Bilingual in English and Spanish is preferred.

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