Job description
Duties:
policies and procedures in order to investigate, resolve and/or facilitate resolution of simple to moderately complex issues.
and/or questions reported by Texas Children's Health Plan (TCHP) members, prospective members, healthcare providers, or
other entities relating to TCHP Managed Care Organization. To be the first point of contact for assistance or information
regarding eligibility, benefits, authorizations, claims, referrals and/or any other Member/Provider needs. To assist and
advocate for Members and/or Providers throughout the complaint and appeal process. To assist Members with timely
appointment scheduling. Responsibility A: Supports the Health Plan call center’s day to day operations.
- Handles calls from Members/Providers seeking assistance with Member and/or Provider related issues. Reviews systems to
and external resources and creates appropriate responses.
- Acts as a liaison and advocate for the Members/Providers.
- Gathers information to support decisions or recommendations for action needed to resolve Member/Provider questions,
- Assists with real-time resource management.
- Interacts tactfully and empathetically with Members/Providers.
- Ensures HIPAA protections are in place by verifying the identity of all callers prior to disclosing Personal Health Information
- Completes all assigned work queue tasks and/or after hour call center vendor notifications.
- Completes necessary documentation thoroughly, accurately, and timely in TCHP or TCH systems e.g., MACESS or EPIC when
- Alerts team leader of any issues or concerns that require escalation for complete resolution, or which may indicate a larger
Skills:
- The ability to work well with the public and adopt a customer perspective and work well individually and in a team
- Effective interpersonal skills and phone etiquette are required
- Strong verbal communication skills
- Good listening skills
- Knowledge of medical terminology
- Problem identification and problem-solving skills and able to multitask
- Technical Skills: Typing, 35 WPM
- Bilingual (English Spanish) preferred
Required
- CALL CENTER CUSTOMER SERVICE
Education:
H.S. Diploma or GED- Required
3 year- Customer service experience within managed care or insurance industry Or
Call center experience in any industry- Required.
Location:
Houston Address: 6330 West Loop South, HEALTHPLAN*Health Plan - WLS
Postal Code: 77401
Hours:
Onsite during training- reliable and dependable candidates are able to work remote after proven performance evaluations and training is complete. must be flexible to work 7am-7pm Monday-Saturday
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