Customer Experience Specialist I - Care 'N Care - Health Plan, SWHR

Education

• High School Diploma or equivalent required.
• Bachelor’s Degree preferred.

Experience

• Highly prefer 2 years’ experience in Customer Service, Sales or Account Management in Medicare, Medicare Advantage, or other applicable Health Plan.
• Prefer 2 years’ experience with PPO's and HMO's, Employer Group and Commercial insurance.
• Prefer 2 years multi-functional high volume customer interaction handling experience.

Skills & Abilities

• Must be a fast learner and ability to multitask between multiple systems to complete required 90-day training program.
• Thorough knowledge of CMS guidelines processes and systems.
• Excellent problem solving and organizational skills as well as strong interpersonal communication skills.
• Must possess strong oral and written communication skills, both in person and telephonically.
• Must possess planning and problem-solving skills and be skilled in diplomacy regarding de-escalation and call control.
• Ability to work on special projects independently or as a team Excellent knowledge of Microsoft Office suite of products

Position Responsibilities

The Customer Experience Specialist I will serve customers via telephonic, electronic, and in person methods and should always be prepared to facilitate support in this manner.

Position Functions

• Provide 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.

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, 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.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• 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