Job Description
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
Childrens Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
JOB SUMMARY: Responsible for accomplishing their primary goal of providing support and rendering Excellent Customer Service by addressing all Health Plan Members calls related to inquiries, questions and concerns in all areas including enrollment, benefit interpretation and eligibility for medical care. Serving assistance to one/maximum two Lines of Business. Maintains confidentiality per HIPAA guidelines..
JOB SPECIFICATIONS AND CORE COMPETENCIES
Essential Functions
- 40% Call Handling: Answer and document Members calls related to inquiries, questions and concerns in all areas including eligibility and status of claims and authorizations. Specifically, have the knowledge and acumen to accurately and concisely provide responses with the primary goal being that Excellent Customer Service is rendered in every connection with our Members.
- 40% Customer Service: Offer Excellent Customer Service through daily phone interaction with Members which is captured during Quality Monitoring.
- 15% Maintains a professional behavior and exhibit excellent interpersonal skills.
Marginal Functions
- 5% Other Duties as assigned
Reports to Position Title: Customer Svc Center Supervisor
Employees Supervised Titles: N/A
MINIMUM QUALIFICATIONS:
- Education/Specialized Training/Licensure: High School Diploma or GED equivalent
- Work Experience (Years and Area): 1-year Customer Service and/or Health Care / Plan experience in a call center or in a face to face setting.
- Software Proficiencies: Microsoft Office (Word, Excel, Outlook)
Job Family/Job Title Competencies
The following competencies apply to this job family:
- Analytical Thinking
- Attention to Detail
- Responding Sensitively
List any additional competencies not indicated above:
- Bilingual (Spanish/Vietnamese) Preferred
- Writing /Composing