Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. $3,500 Sign-on Bonus Offered!

GENERAL PURPOSE OF JOB

The Customer Service Representative is responsible for the assisting Member/ Provider with healthcare inquires 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: o Abuse, Neglect and Exploitation o Authorizations o Behavioral Health o Claims o Complaints o Crisis Calls o Eligibility o Health Insurance Benefits o Locating providers o Pharmacy Benefits o Transportation o 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 Until all children are well.

Driscoll Children's Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll's approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll's rich history and explore the laidback lifestyle South Texas has to offer.