Customer Care Representative - SHP Customer Service - Virtual - Day Shift - Per Diem

Hours:

Shift Start Time:
Variable Shift End Time:
Variable AWS Hours Requirement: 8/40 - 8 Hour Shift Additional Shift Information:
Weekend Requirements:
As Needed On-Call

Required:

No Hourly Pay Range (Minimum
- Midpoint
- Maximum): $28.100 - $35.040 - $39.240 The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

• Responsible for direct and timely communication between the Plan and Plan members, potential members, providers, employer groups, brokers, internal departments and external agencies.
• Maintains high level of knowledge regarding Plan products, premiums, benefits and procedures.
• Uses knowledge and judgment to select appropriate resources for assisting callers.
• Provides information on all aspects of Plan products, premiums, benefits, policies and procedures.
• Responsible for accurate problem-solving.
• Researches and resolves concerns.

• H.S. Diploma or Equivalent
• Less Than 1 Year Minimum of six (6) months experience as a Customer Call Center Representative.

• Associate's Degree Business administration or health care administration ( including courses of study in accounting, finance, marketing, and health care administration)
• 2 Years Customer service or medical office experience.
• 1 Year Experience working full time as SHP Customer Care Temporary CCR I.
• Other Qualification Requirements Medical office certification, to include medical terminology, preferred.

• Access patient data Documents all calls in the IDX Customer Service Module immediately.
• Verifies prescription drug eligibility, benefits, claims, and authorizations in PBM's Med Access system.
• Adds and updates member information in the Med Access system.
• Maintains current knowledge of IDX system modules for Registration, Enrollment, Claims, Utilization Management and Premium Billing.
• Verifies enrollment, benefits premiums and other individual and group information in Salesforce.
• Generates member letters using Globalworks.
• Retrieves member documents stored in OnBase.
• Uses Sharp Connect to assist members with online inquires.

• Ability to understand and resolve common Commercial member inquires/complaints by phone.
• Provides prompt, accurate and excellent services to internal and external customers.
• Develops solid professional working relationships with various internal departments and units and, as required, vendors, providers, employers, brokers and/or other customers.
• Works collaboratively with other Plan and medical group departments to address customer questions and concerns, including Health Services, Enrollment, Claims Research, Underwriting.
• Works collaboratively with health care providers and office staff to facilitate access to care.
• Maintains a complex and evolving knowledge of health insurance and health care reform mandates.

Participates in special projects and other duties as assigned. These may include, but are not limited to, work groups, proposals, audits and back-up support for other departments.

Assists new and existing members in attaining a workable understanding of their health coverage, clarifies terminology in enrollment materials, and instructs members regarding how to utilize the services of the Plan and the provider network. Answers inquiries from potential members, members, brokers, employer groups, State and County representatives, Plan providers, internal departments, and all other callers, including:

• a) Verification of eligibility, enrollment and PCP assignment;
• b) Benefit, co-payment, and referral questions;
• c) Requests for PCP changes, address changes, , benefit materials;
• d) Inquiries regarding premium and subsidy amounts and balances;
• e) Clarification of conversion, COBRA, and Cal-COBRA enrollment procedures, including quotes of approximate rates.

Documents member concerns, complaints, and appeals, and forwards to the appropriate Customer Care Lead or Supervisor on a daily basis. If unable to provide immediate assistance, promptly returns calls with answers and resolutions. Utilizes appropriate handbooks, Evidence of Coverage, supplemental benefit information, and other reference material as needed to quote Plan benefits, exclusions, and policies.

• a) Operations policies and procedures
• b) All Combined Evidence of Coverage (Member Handbooks) and Employer Group Benefit Agreements
• c) Language Line.

• a) Forwarding prospects for new brokers or employer groups to Marketing;
• b) Working with Health Services regarding…