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Call Center Representative/Customer Service
eTeam Inc - Southwest Houston, TX
posted 2 months ago
About the position
The Call Center Representative serves as a Member and Provider Advocate for Texas Children's Health Plan (TCHP), addressing inquiries and resolving issues related to eligibility, benefits, authorizations, claims, and referrals. This role is essential in providing support to members and healthcare providers, ensuring a smooth complaint and appeal process, and assisting with appointment scheduling. The position requires effective communication and problem-solving skills to handle a variety of customer service tasks in a remote setting.
Responsibilities
- Verify member eligibility through THMP and provide support for this activity for Call Center Representatives.
- Act as a secondary resource to Call Center Representatives in the absence of the Team Lead.
- Respond to escalated calls and triage to Management if necessary.
- Assist with processing workflow queues, ensuring timely submission of urgent requests as directed by the Team Lead.
- Assist with onboarding new hire employees in a Nesting environment, providing job shadowing and mentorship.
- Complete and manage the Pharmacy queue / Right Fax.
- Assist members/providers with billing inquiries and resolve billing issues.
Requirements
- High school diploma or GED required.
- 1 year of Medicaid experience required.
- 1 year of call center management experience required.
- 1 year of health insurance experience required.
- 1 year of bilingual experience required.
- Knowledge of managed care, Medicaid, and call center desktop support applications.
Nice-to-haves
- Experience in benefits, claims processing, or membership knowledge preferred.
- Strong verbal communication skills and effective interpersonal skills.
- Good listening skills and problem identification and solving skills.
Benefits
- 401(k)
- Dental insurance
- Flexible schedule
- Health insurance
- Paid time off
- Vision insurance
