Health Plan Call Center Representative Trainee

7 days ago


Fort Worth, Texas, United States Workforce Solutions for Tarrant Co. Full time
Job Description:

The Health Plan Call Center Rep Trainee will undergo comprehensive training to excel in a Call Center Rep 1 position. This role requires providing exceptional service to Cook Children's Health Plan Members and Providers in a fast-paced environment. Key responsibilities include delivering quality services by responding promptly and courteously to inquiries, directing when possible, or collaborating with other CCHP team members to resolve issues.

Essential Job Functions:
  • Benefits/Eligibility/Member Updates: Enhance the customer experience by utilizing effective questioning and listening skills when interacting with Members and their authorized representatives. Skillfully diffuse frustrated callers by identifying and finding solutions to Member issues, while maintaining confidentiality and adhering to departmental policies and procedures.
  • Member Education: Educate and guide Members through the complexities of the programs using clear and concise instructions. Utilize available resources to assist Members in making informed decisions regarding their health, and support efforts to assist Members with renewal requirements.
  • Core System: Update Member accounts with accurate PCP and demographic information. Document all Member-related interactions using correct grammar and terminology into CCHP's core system for accurate tracking and analysis of data and trends. Route and report identified trends with providers to the management team.
  • Issue Resolution: Gather relevant information regarding complaints and grievances, and accurately document the Member's account. Collaborate with other CCHP departments as needed to resolve Member complaints and grievances, ensuring timely information is sent to the Compliance Department.
  • Cultural Sensitivity: Utilize cultural sensitivity during interactions with Members. Schedule face-to-face interpreters for non-English speaking Members for medical appointments. Use CCHP's TTY hearing impaired phone or Texas Relay to communicate with hearing impaired Members.
  • Customer Service: Meet and maintain a score above 87% for Customer Service Call/Notes Accuracy, as monitored by the Quality Department. Meet and maintain all approved phone metrics while delivering high standards of customer service.


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