Job Title - Call Center Representative

Location - Houston, TX 77401

Duration -3 + months

Shift- 9 am-5:30 pm

Pay Range- $18.00/hr- $20.00/hr

Note - 9 am-530pm-Training will be onsite and once cleared the position in Remote contingent upon performance

Job Duties

• Serve as a Member and/or Provider Advocate by understanding the organization’s processes, policies, and procedures.
• Investigate, resolve, and facilitate the resolution of simple to moderately complex issues reported by TCHP members, prospective members, healthcare providers, or other entities.
• Act as the first point of contact for inquiries related to eligibility, benefits, authorizations, claims, referrals, and other Member/Provider needs.
• Assist and advocate for Members and/or Providers throughout the complaint and appeal process.
• Assist Members with timely appointment scheduling.
• Handle calls from Members/Providers seeking assistance with related issues.
• Review systems to identify issues, research thoroughly, collaborate with departments, communicate with internal and external resources, and provide appropriate responses.
• Act as a liaison and advocate for Members/Providers.
• Gather information to support decisions or recommendations for action needed to resolve issues or concerns.
• Assist with real-time resource management.
• Interact tactfully and empathetically with Members/Providers.
• Ensure HIPAA compliance by verifying the identity of all callers before disclosing Personal Health Information (PHI).
• Complete all assigned work queue tasks and after-hour call center vendor notifications.
• Accurately document information in TCHP or TCH systems (e.g., MACESS or EPIC).
• Alert team leader of any issues or concerns requiring escalation or indicating larger problems.

Skills:

• Knowledge of managed care, customer service, call center desktop support applications, and general computer literacy.
• Ability to work well with the public and adopt a customer-focused perspective, both independently and in a team environment.
• Effective interpersonal skills and phone etiquette.
• Strong verbal communication skills and good listening ability.
• Knowledge of medical terminology.
• Problem identification, problem-solving skills, and the ability to multitask.
• Typing speed of 35 WPM.
• Bilingual (English-Spanish) preferred.
• 1 year of customer service experience within the managed care or insurance industry, or call center experience in any industry.

Education:

• High School Diploma or GED