CareNational Hiring for Healthcare Call Center Representative Job at Horseshoe Bay, TX Full Time

Customer Service Representative Job Summary:

• Addresses member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care.
• Verify member eligibility, claim and authorization status for providers.
• Responsible for thorough follow-up and completion of all member, and provider inquires or requests
• Responsible for accurate, complete and correct documentation into Facets regarding all issues, and/or inquires, complaints and grievances
• Function efficiently and productively in a high-volume telephone call center.
• Maintain departmental productivity and quality standards.
• Provide follow-up assistance as needed
• Route escalated calls to the appropriate Member Liaison, Supervisor or Call Center Manager
• Refer issues to health networks and/or make recommendations for further contacts
• If designated, responsible for processing all member transportation request within 1 business day of receipt and coordinating all aspects of the process with clinic, provider and member as appropriate or necessary

Customer Service Representative Background:

• Requires an education level of at least a high school diploma or GED.
• Around 1 year customer service experience with at least 6 months experience in an office setting, call center setting, or phone support role.
• Healthcare experience is required, including basic familiarity with medical terminology.
• Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
• Knowledge of health care delivery system, Medicaid/Medicare and related state programs is a significant plus.
• Computer skills to include Microsoft Word, Excel and basic data entry, including the ability to learn new and complex computer system applications.
• Must test at a minimum of 30-40 wpm typing with a high level of accuracy.