Customer Care Representative

Customer Care Representative

The Customer Care Representative position is responsible for providing support to health plan members and providers, serving as a resource for staff and community medical personnel by performing the following duties. This is a seasonal temporary position starting now till March 2027. The available schedules are Monday-Friday 8am to 5pm and weekends are 11am-8pm:

• Monday
  - Friday (Full-Time) Occasional weekend availability may be required with advance notice.
• Wednesday
  - Sunday (Full-Time)
• Thursday
  - Sunday (Part-Time)

Essential Duties

• Ensure customer satisfaction and provide professional customer support.
• Speaks with members or member's representatives and providers by phone or in person. Topics may include:
  Oregon Health Plan/CCO benefits and information, Medicare Advantage Plan benefits and information, Contract interpretation, Procedures, Billing, Subscriber problems, and/or Denied Services.
• Responds to requests for managed care information for all product lines and subsidiaries.
• Maintains knowledge of all contracts, programs, and benefits offered through the Coordinated Care Organization/CCO and the Medicare Advantage Plan.
• Resources and responds to information requested from claims analyst on pending claims.

Job Duties

• Ensure customer satisfaction and provide professional customer support.
• Speaks with members or member's representatives and providers by phone or in person. Topics may include:
  Oregon Health Plan/CCO benefits and information, Medicare Advantage Plan benefits and information, Contract interpretation, Procedures, Billing, Subscriber problems, and/or Denied Services.
• Responds to requests for managed care information for all product lines and subsidiaries.
• Maintains knowledge of all contracts, programs, and benefits offered through the Coordinated Care Organization/CCO and the Medicare Advantage Plan.
• Resources and responds to information requested from claims analyst on pending claims.
• Maintaining a positive, empathetic, and professional attitude toward customers at all times.
• Responding promptly to customer inquiries.
• Communicating with customers through various channels.
• Acknowledging and resolving customer complaints.
• Administers policies consistently and in accordance with the contracts.
• Works collaboratively with internal staff as the need arises.
• Develops and maintains strong information based on managed care systems.
• Responds to grievances and appeals involving members and providers.
• Ensures that supervisor is kept apprised of problems by way of accurate record keeping and by discussion at the time of receipt of significant problems.
• Receives inquiries from members and providers regarding problem claims and routing these issues to the appropriate person or department for a resolution.
• Responds in a timely manner and documenting the action taken.
• Must maintain confidentiality of providers, members, and employees.
• Researches provider problems and report findings to provider staff or the appropriate person.
• Contacts the member's case manager in order to avoid negative outcomes, emergency room visits, or inpatient stays.
• Works on weekends and evening shifts when needed by the department.
• Maintains punctual, regular and predictable attendance.
• Works collaboratively in a team environment with a spirit of cooperation.
• Respectfully takes direction from leadership.
• Meets all required training including those listed in Relias Learning Module System (LMS).
• Performs other duties as assigned.

Qualifications

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. 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 duties.

Education & Experience

• High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

Language Skills

Ability to read…