Customer Experience Specialist I - Care 'N Care
Thanks for your interest in the Customer Experience Specialist I - Care 'N Care position.
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Qualifications
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High School Diploma or equivalent (required)
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Bachelor's Degree (preferred)
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2 Years Customer Service, Sales or Account Management experience in Medicare, Medicare Advantage, or other applicable Health Plan experience and be comfortable and familiar with PPO's and HMO's, Employer Group, and potentially Commercial insurance (preferred)
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2 Years Multi-functional High-Volume Customer Interaction handling experience (preferred)
Position Responsibilities SWHR Customer Experience Specialist I provides exceptional service across entire health plan customer base via telephonic, electronically or in person methods as applicable. Serve health plan member population, prospective members, sales agents and healthcare providers with issues including but not limited to benefits and eligibility validation, claims status and complex claims routing, billing, enrollment, provider search, PCP assignment and appointment setting, provider portal questions, benefit education, appointments and RSVP processing, assist with incoming enrollment facilitation, may assist in supporting health plan events, prior authorization status, pharmacy inquiries, provider dispute, appeals and grievance and other inquiries as presented. Identify proper protocol routing, triage and escalation as necessary as well as full accountability of follow through and close out, including clear and relative documentation of standard and escalated issues at all times. Maintain personal metrics to established performance levels of the individual and team. Responsibilities may vary depending on seasonal business needs. Proactive telephonic outreach and engage customer base as necessary which may involve various customer interactions including but not limited to welcoming new members to the health plan, customer retention and loyalty, quality healthcare initiatives, PCP updates, and other special projects as assigned. Research and clearly document complex issues across multiple databases and work with support resources, internally and externally, as applicable to resolve customer issues and/or partner with others to resolve escalated issues and submission of appeals, grievances, disputes and/or complaints from entire customer base.
In addition to the required qualifications, a successful Customer Experience Specialist I will:
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broad understanding of financial and accounting principles.
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must be a fast learner and ability to multitask between multiple systems to complete required 90-day training program
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thorough knowledge of CMS guidelines processes and systems
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excellent problem solving and organizational skills as well as strong interpersonal communication skills
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must possess strong oral and written communication skills, both in person and telephonically
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must possess planning and problem-solving skills, and skilled in diplomacy regarding de-escalation and call control
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ability to work on special projects independently or as a team
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excellent knowledge of Microsoft Office suite of products
Why Southwestern Health Resources
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
We invite you to learn more about us at www.southwesternhealth.org.
Let’s move healthcare forward – together.
Highlights:
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Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
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SWHR is the parent organization of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.
Additional perks of being a SWHR Customer Experience Specialist I
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Gain a sense of accomplishment by contributing in a teamwork environment
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Positively impact patients’ quality of life
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Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
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Enjoy opportunities for growth
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.
Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org.