Customer Engagement Representative

Overview

This position represents the front door of the organization to ensure health care is received timely with an exceptional customer experience. The Customer Engagement Representative acts as a liaison, primarily a patient advocate, between Renown, Hometown Health, its customers, and community members by processing requests, complaints, concerns, providing education in utilizing the resources and services of the organization resulting in “first call resolution”.

The successful candidate will provide an excellent experience in a professional, expedient, and proficient manner. This role serves as the voice of the customer and engages with peers, office staff, and leaders to resolve or escalate questions and concerns. This is a personally fulfilling role as it provides the opportunity to make a genuine difference in each life that is touched.

This position is responsible for working in a fast-paced environment using several modes of communication including face-to-face, video conferencing, telephone, chat, messaging, and email. The representative must be able to master systems and technology associated with the role and be comfortable working efficiently while multitasking. The representative must have excellent interpersonal skills to understand customer inquiries or complaints and manage through potential difficult conversations.

The representative must maintain this level of service while working with complex situations and high volumes. The representative will act as the voice of the customer, advocating on their behalf to ensure they receive best in class service by proactively identifying and escalating priority issues, de-escalating when appropriate, and going above and beyond to meet customer needs. They must be able to learn quickly to acquire the service and product knowledge to answer customers’ questions accurately.

Their work must be concise and accurate. They must have good knowledge of telephone and computer systems to use engagement center systems efficiently. This will be done in a consistently service-oriented manner to provide the highest level of satisfaction. The representative makes no medical necessity decisions.

• Provide excellent service utilizing basic knowledge of all services supported for Hometown and Renown Health.
• Follow established standard policies and procedures to complete pertinent tasks, meet customer needs, and work for one call resolution.
• Answering and routing a high volume of inbound/outbound interactions through multiple channels and computer software systems. Communicating with customers to resolve inquiries using various platforms.
• Coordinating healthcare services including appointment scheduling, updating patient records, obtaining authorizations, communicating with care teams, arranging transportation, paging on-call physicians, escalating patient concerns, general complaint and grievance resolution, basic navigation of the healthcare system, providing technical support, and payment collection.
• Provide appropriate responses to customers regarding Plan benefits, including eligibility, benefit quoting, provider network, referral and authorization process, claims payment, and applicable policies and procedures.
• Work effectively with professionals across the health system including providers, social workers, case managers, nurses, medical assistants, patient access representatives, insurance companies, and other third parties.
• Handle inquiries related to compliance and regulatory auditing.
• Performs other duties as required and meets/exceeds performance goals to ensure departmental and organizational goals are achieved.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Requirements - Required and/or Preferred

• Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. A college degree or equivalent experience is preferred but not required.
• Experience: Must have strong customer service skills. Strongly preferred 1-2 years of experience in a position involving customer service, healthcare, or health insurance. Ability to speak Spanish is desired.
• License(s): None
• Certification(s): None
• Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word, and able to use a computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Ability to type an average of 40 WPM. Experience with electronic medical record systems is a plus.