Customer Service Representative

Altus Accountable Care Entity (ACE) is a physician‑led organization empowering doctors to deliver high‑quality, value‑based care within their communities. Altus ACE works in partnership with Managed Care Organizations to provide care coordination services directly to patients in the STAR+PLUS, STAR+PLUS MMP (dual eligibles) and Medicare Advantage programs. Our unique community‑based care model achieves quality results and healthcare savings that are shared with our physician partners.

Job Title: Customer Service Representative (Medicaid & Medicare)

Reports To: Member Engagement Manager

Location: Houston, TX

Salary: Up to $15 per hour Depending on Experience

Status: Hourly, Non‑exempt

Number of Openings: 3

Summary:

Entry level call center customer service position. The identified individual will perform outbound calls to Altus ACE members in order to assist and facilitate access to healthcare, community, and other services as needed. Customer Service Representatives will be required to monitor follow‑through on needed care and follow‑up on open issues.

Individuals will work closely with clinical staff to assist members in resolving healthcare and psychosocial related issues. In addition, they must maintain an outreach effort which includes calls welcoming members into the program, 45‑day follow‑up calls, child wellness care. Nurture and maintain open communication in order to educate members on the understanding of the program.

• Perform a required number of outbound calls to schedule appointments for members pertaining to wellness, appointment reminders and designated call campaigns as required.
• Assist with coordination of member’s health care and social service needs in conjunction with the Clinical Operations department by gathering outstanding member questioners.
• Notify members of plan specific current value added services.
• Accurately document and/or update member interactions within designated database.
• Maintain acceptable abandoned call rates, average handle time, productivity percentage, and attendance as outlined by Altus ACE.
• Other projects and duties as assigned.

Required Skills

• The ability to develop and maintain effective interpersonal relationships with internal and external contacts at all levels.
• Ask appropriate questions and listen actively to identify any questions or issues while documenting required information in member engagement portal.
• Maintain accurate records and documentation.
• Communicate effectively, both verbally and in writing with individuals from varying cultural and ethnic backgrounds.
• Principles and techniques to serve the SPD population in diverse social and ethnic groups.

Qualifications:

• Knowledge of managed care/insurance environments, risk contracting and claims resolution, and healthcare reform.
• Strong interpersonal skills in order to communicate effectively with internal/external customers, providers, and all levels of organizational leadership.
• Computer skills in MS‑Office is required, including Excel, Word, and PowerPoint.

Education/Experience

• 1-2 years experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity required.
• 1-2 years working in a high volume call center with outlined metrics to meet required.
• Will consider individuals with 2+ years of call center customer care experience.
• Knowledge Medicare, Medicaid and health services experience preferred.
• Previous medical office experience preferred.
• Bilingual in English/Spanish or English/Vietnamese is highly preferred.

All your information will be kept confidential according to EEO guidelines.

Reasonable Accommodations:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.