Customer Care Representative
Express Employment Professionals
- Grants Pass, OR
- Permanent
- Full-time
- Ensure customer satisfaction and provide professional customer support.
- Speaks with members or member's representatives and providers by phone or in person. Topics may include: Oregon Health Plan/CCO benefits and information, Medicare Advantage Plan benefits and information, Contract interpretation, Procedures, Billing, Subscriber problems, and/or Denied Services.
- Responds to requests for managed care information for all product lines and subsidiaries.
- Maintains knowledge of all contracts, programs, and benefits offered through the Coordinated Care Organization/CCO and the Medicare Advantage Plan.
- Resources and responds to information requested from claims analyst on pending claims.
- Ensure customer satisfaction and provide professional customer support.
- Speaks with members or member's representatives and providers by phone or in person. Topics may include: Oregon Health Plan/CCO benefits and information, Medicare Advantage Plan benefits and information, Contract interpretation, Procedures, Billing, Subscriber problems, and/or Denied Services.
- Responds to requests for managed care information for all product lines and subsidiaries.
- Maintains knowledge of all contracts, programs, and benefits offered through the Coordinated Care Organization/CCO and the Medicare Advantage Plan.
- Resources and responds to information requested from claims analyst on pending claims.
- Maintaining a positive, empathetic, and professional attitude toward customers at all times.
- Responding promptly to customer inquiries.
- Communicating with customers through various channels.
- Acknowledging and resolving customer complaints.
- Administers policies consistently and in accordance with the contracts.
- Works collaboratively with internal staff as the need arises.
- Develops and maintains strong information based on managed care systems.
- Responds to grievances and appeals involving members and providers.
- Ensures that supervisor is kept apprised of problems by way of accurate record keeping and by discussion at the time of receipt of significant problems.
- Receives inquiries from members and providers regarding problem claims and routing these issues to the appropriate person or department for a resolution.
- Responds in a timely manner and documenting the action taken.
- Must maintain confidentiality of providers, members, and employees.
- Researches provider problems and report findings to provider staff or the appropriate person.
- Contacts the member's case manager in order to avoid negative outcomes, emergency room visits, or inpatient stays.
- Works on weekends and evening shifts when needed by the department.
- Maintains punctual, regular and predictable attendance.
- Works collaboratively in a team environment with a spirit of cooperation.
- Respectfully takes direction from leadership.
- Meets all required training including those listed in Relias Learning Module System (LMS).
- Performs other duties as assigned.
- High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.
- Ability to stay calm when customers are stressed or upset.
- Attentive, empathetic, and want to learn.
- Collaborates and finds ways to work with our diverse culture.
- Ability to work with people with mental illness and from diverse backgrounds and experiences.
- Ability to work extended hours to see issues through to resolution.
- The employee must be able to work onsite for all scheduled shifts.