Call Center Rep. - Integrated Resources, Inc

Job Title: Call Centre Representative
Job Location: Bellaire, TX (Hybrid)
Duration: 3 Months

Job Description:
To serve as a member and/or Provider Advocate by possessing knowledge and understanding of the organization's processes, policies and procedures to investigate, resolve and/or facilitate resolution of simple to moderately complex issues and/or questions reported by members, prospective members, healthcare providers, or other entities relating to 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.

Responsibilities:

• Supports the Health Plan call centre s day to day operations
• Handles calls from Members/Providers seeking assistance with Member and/or Provider related issues. Reviews systems to identify issues, comprehensively researches the issues, collaborates with other departments, communicates with internal 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, issues, and/or concerns.
• 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 (PHI).
• Completes all assigned work queue tasks and/or after hour call centre vendor notifications.
• Completes necessary documentation thoroughly, accurately, and timely in Client systems e.g. MACESS or EPIC when applicable.
• Alerts team leader of any issues or concerns that require escalation for complete resolution or which may indicate a larger underlying problem.
• Someone with inbound call centre experience preferably in healthcare and general healthcare experience

Required:

• Call Centre and Healthcare experience, preferred -- billing/coding knowledge
• Training will be onsite and once cleared the position in Remote contingent upon performance

• Knowledge of managed care, customer service, call centre desktop support applications, and general computer literacy
• The ability to work well with the public and adopt a customer perspective and work well individually and in a team environment.
• 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

Schedule Notes:

• 9:00 AM -5:30 PM - Training will be onsite and once cleared the position in Remote contingent upon performance