HP Customer Serv Rep Non Bil

## HP Customer Serv Rep Non Bil Apply locations:
Corpus Christi, TXtime type:
Full time posted on:
Posted Yesterday job requisition :
JR112087#
**** Where compassion meets innovation and technology and our employees are family.
***** Thank you for your interest in joining our team! Please review the job information below.****$3,500 Sign-on Bonus Offered!
***** GENERAL PURPOSE OF JOB:
** The Customer Service Representative is responsible for the assisting Member/ Provider with healthcare inquires concerns, or complaints via telephone.
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* ESSENTIAL DUTIES AND RESPONSIBILITIES:

** To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as  assigned by the immediate supervisor and/or health plan administration, as required.

** General Duties:
** Assist members and providers by responding to telephone inquiries in a prompt, accurate and objective manner regarding but not limited to:
o Abuse, Neglect and Exploitation  o Authorizations  o Behavioral Health  o Claims  o Complaints  o Crisis Calls  o Eligibility  o Health Insurance Benefits  o Locating providers  o Pharmacy Benefits  o Transportation  o Waste Abuse and Fraud     
• 90% of the scheduled time on the phone according to business needs.  
• Drives resolution of caller questions/issues on the first call whenever possible and ensures proper documentation of calls and resolution actions.  
• Understand and adhere to HIPAA requirements.  
• Adhere to Regulatory Guidelines and policies & procedures.  
• Navigating through complex computer systems to identify the status of the issue and provide appropriate response to 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 problem 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.
** EDUCATION AND/OR

EXPERIENCE:

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* • Minimum of a high school diploma or equivalent  
• Customer service experience  
• Experience working in a call center or healthcare related field is a plus  
• Strong customer service skills, including courteous telephone etiquette and professionalism  
• Prior understanding and awareness of call center metrics and goals preferred  
• Prior healthcare experience, in particular, Medicaid Insurance Plans preferred  
• Ability to type a minimum of 35 words per minute  
• Knowledge of managed care processes and health insurance coverage preferred  
• Knowledge of medical terminology preferred  
• 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 a part of a team
• Ability to operate computer programs – Proficiency with Microsoft Office applications, particularly Outlook, Word, and MS Teams
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