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HP Customer Service Rep Bilingual

HP Customer Service Rep Bilingual

Driscoll Children's HospitalCorpus Christi, TX, US
18 days ago
Job type
  • Full-time
Job description

Where Compassion Meets Innovation and Technology

Thank you for your interest in joining our team! Please review the job information below.

Sign-on Bonus Offered!

This position is 100% onsite.

General Purpose Of Job :

The Bilingual Call Center Customer Service Representative is responsible for assisting members and providers with healthcare inquiries, concerns, or complaints via telephone.

Essential Duties And Responsibilities :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and / or health plan administration, as required.

General Duties :

Assist members and providers by responding to telephone inquiries in a prompt, accurate and objective manner regarding but not limited to : Abuse, Neglect and Exploitation, Authorizations, Behavioral Health, Claims, Complaints, Crisis Calls, Eligibility, Health Insurance Benefits, Locating providers, Pharmacy Benefits, Transportation, Waste Abuse, and Fraud.

  • 90% of the scheduled time on the phone according to business needs.
  • Drives resolution of caller questions / issues on the first call whenever possible and ensures proper documentation of calls and resolution actions.
  • Understand and adhere to HIPAA requirements.
  • Adhere to Regulatory Guidelines and policies & procedures.
  • Navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller.
  • Review previous call interactions / notes.
  • Communicate monthly messages to members and providers on a specific need basis.
  • Deal tactfully and empathetically with members and providers.
  • Establish and maintain effective working relationships with provider office staff.
  • Read, comprehend, and verbalize processes and procedures of the organization and of health insurance coverage.
  • Multi-task by utilizing multiple complex computer applications.
  • Pay close attention to detail.
  • Identify issues / trends and escalate to Supervisor / Manager when assistance is needed.
  • Develop relationships with other departments to provide feedback about root cause issues.
  • Intervene with providers on behalf of the customer to assist with appointment scheduling or connections with specialists for assistance when needed.
  • Assist customers in navigating through the Driscoll Health Plan website and encourage and reassure them to become self-sufficient.
  • Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member and or provider.
  • Research complex issues across multiple databases and work with internal departments to resolve customer issues and / or partner with others to resolve escalated issues.
  • Other duties as assigned.

Education And / Or Experience :

  • Minimum of a high school diploma or equivalent
  • Customer service experience
  • Experience working in a call center or healthcare-related field is a plus
  • Strong customer service skills, including courteous telephone etiquette and professionalism
  • Prior understanding and awareness of call center metrics and goals preferred
  • Prior healthcare experience, in particular, Medicaid Insurance Plans preferred
  • Ability to type a minimum of 35 words per minute
  • Knowledge of managed care processes and health insurance coverage preferred
  • Knowledge of medical terminology preferred
  • Outstanding communication skills and the ability to understand complex situations to effectively handle escalated customer needs
  • Analytical skills and the ability to read and interpret data
  • Problem solving abilities
  • Ability to work independently and as a part of a team Ability to operate computer programs Proficiency with Microsoft Office applications, particularly Outlook, Word and MS Teams

    • English Language Skills :

  • Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
  • Ability to speak English and Spanish required.
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    Customer Service Rep • Corpus Christi, TX, US