Customer Service Associate, HYRBID

Job Description - Customer Service Associate, HYRBID (2500039T)

Hybrid position: 4 days in office + 1 day telework per week

Position also requires on-call coverage in staff rotation (1 week every 5-6 weeks). Additional compensation for on-call coverage.

As a Customer Services Associate you will work to resolve customer phone inquiries related to claims, eligibility verification, prior authorizations, pharmacy related issues and more. You will utilize strong verbal and written communication, listening and organizational skills as well as problem-solving and reasoning skills to accomplish superior customer service. Further, you will demonstrate attention to detail, ability to work in an ever-changing workflow environment, patience, professionalism, and compassion while handling difficult customers and situations.

You will support enrollees and their families throughout their enrollment with HSCSN, by providing around-the-clock access to resources and assist with care coordination. A successful candidate will show flexibility and a customized approach when interacting with all types of enrollee communication styles and personalities. Finally, a strong Customer Care Services Associate will take initiative and assume responsibility where appropriate.

Essential job duties:

• Maintain 24/7 customer service access
• Receive calls from enrollees and/or their caregivers, assess the nature of the call, address the needs accordingly or transfer to the appropriate department
• Answer inquiries from enrollees and/or their caregivers regarding eligibility, benefits, services, provider access and availability, and special events and programs
• Update and maintain enrollee demographics to include address, telephone number, email, emergency contact information
• Process requests for PCP/PDP change and issuance of new or replacement Health Plan  as necessary
• Facilitate oral and in-person interpretation and translation services for enrollees and/or caregivers
• Assist enrollees and/or their caregivers in scheduling appointments for doctor and hospital visits, dental appointments, transportation and coordinating with retail pharmacies on prescription needs
• Answer inquiries from providers on various topics such as: eligibility status of enrollees, claims filing instructions and claims status, and authorization status
• Utilize telephonic technology tools to ensure all customer issues are tracked and resolved in a timely manner
• Triage calls and escalations to other departments within HSCSN as appropriate

Other job duties:

• May perform other duties in addition to those outlined in this job description.

• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence standard is achieved
• Innovates through improvement of care and/or efficiency of operational processes.
• Dedicated to a standard of performance excellence and high quality

• Embraces changes/improvements and actively participates in the implementation of new/improved programs, technology, new equipment, systems and resources that promote quality of care, safety and efficiency
• Identifies, prioritizes and selects alternative solutions to determine best outcome

• Maintains a high level of activity/productivity, meeting deadlines and appropriately prioritizing tasks to meet business demands
• Anticipates problems and attempts to solve before they develop

• None
• Category III:
  Job does not involve exposure to blood, body fluids, non‑intact skin or tissue specimens. Incumbent does not perform or help in emergency medical care or first aid as a part of his/her job.

• Level I - No Access. Incumbents in this job are restricted from access to protected health information.
• This job operates in a hospital or office environment.

• Sedentary Work:
  Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

• Hybrid position: 4 days in office + 1 day telework per week
• Position also requires on-call coverage in staff rotation (1 week every 5-6 weeks). Additional compensation for on-call coverage.

District of Columbia-Washington

District of Columbia-Washington

HSCSN - Vermont Ave 1101 Vermont Ave NW Washington 20005

Administrative Support / Customer Service

HSC W/Special Needs

Position Status: R (Regular) - FT - Full-Time

Shift: Day

Work Schedule:

Monday - Friday 8:30AM - 5:00PM

Feb 27, 2026, 4:35:13 PM

37336 - 57969.6

Health Services for Children with Special Needs (HSCSN) is an equal…