Medical Call Center Representative- Remote
Position
Medical Call Center Representative
Remote Direct Hire, Benefited Positions
Description
Member Services Representative is responsible for being a devoted and compassionate advocate for Members when assisting with maximizing their benefits, navigating the healthcare system, and reaching their optimal health.
Responsible for providing guidance and answering questions from Members about their benefits and medical claims, as well as educating Members about wellness programs.
Assisting Members in assessing tools available to help guide decision-making about complex matters related to their wellbeing.
Facilitate the Member’s selection and access to in-network healthcare providers.
Collaborate with inter-departments to ensure Member needs are met.
1.
Provide Members with health plan education in regard to and Medi-Cal benefit coverage, including understanding coordination of benefits and eligibility rules.
2.
Meet Member Services Call Center standard and policy requirements.
This includes but is not limited to the following: successful completion of Member Services Training, active participation in continuous training, use telephone system and other IEHP equipment appropriately and for professional reasons only, follow required call scripts and adhere to Attendance/Punctuality and Dress Code policy.
3.
Provide superior service that delights caller in all aspects of the interaction including:
a.
Strive to assist caller on the first point of contact.
Demonstrate a high level of patience and respect; avoid distractions to ensure each caller is assisted promptly and appropriately; follow call handle standards and objectives.
b.
Assist with Member primary care/facility assignments, selections and changes; health care options liaison; health education advisory; supply eligibility status of Members to providers
c.
Member education including tagging, material request, programs, ordering ID cards and accessing services.
d.
When necessary present cases to Member Services Management Team and work with other departments to resolve Member and/or Provider inquiries and/or issues.
Including but not limited to transportation requests, interpreter requests, referrals questions/concerns, re-directions, Behavioral Health and Pharmacy inquiries.
e.
Document accurately while speaking with the caller.
Complete Member Satisfaction Surveys and Assessments, as needed.
Over 100% call documentation is required
f.
Proper and timely intake of Member grievances
4.
Coordinate telephonic translation of calls when Members do not speak English or Spanish.
5.
Efficient problem solving, time management, initiative, and focus skills requiring minimum supervision and guidance.
6.
High technological aptitude with efficient adaptability to diverse and changing systems and business conditions.
7.
Ensure key performance indicator goals are met monthly.
8.
Ensure the privacy and security of PHI (Protected Health Information) as outlined in policies and procedures relating to HIPAA compliance.
Demonstrate a commitment to understand and adhere to the Regulatory requirements as they relate to the business unit.
9.
Preserve Member’s confidentiality by authenticating callers (submitting guardianship documents for verification, establish guardianship alerts, authentication passwords and confidentiality alerts as needed).
10.
Demonstrate a commitment to LEAN by participating in process improvement projects and RIE Events/Huddles.
Act as an owner and submit ideas on efficiency gains.
11.
Assist Members with navigating self-service options.
12.
Assist with tracking trends within the department and escalating this information to management.
13.
Review call monitors recordings and develop self-action plans to improve quality assurance scores.
14.
Maintain knowledge of other departments and the roles they play in Member Services standard work processes, to ensure proper handling and tasking of calls.
15.
Comply with Telecommuting Agreement and requirements, as applicable
Requirements
One (1) year of Customer Service experience in a call center, medical or hospitality setting, analyzing and solving customer problems.
HMO or Managed Care Experience preferred.
One (1) year call center experience in a customer services setting preferred.
Medi-Cal program and benefit requirements experience desired.
Additional Information
Full-Time, Benefited, Direct Placement
Remote work from home
Must be available to report on-site once Monthly as required
from California Job Vacancies https://ift.tt/30HfnXi
via https://www.californiajobvacancies.com/customer-service/medical-call-center-representative-remote-07ad81/
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