Health Plan Contact Center Rep. - Remote (Must Reside in Texas)

Remote

Full Time

Clinical Operations - Business Operations

Entry Level

Harbor Health looking for a personable Health Plan Contact Center Representative to become a member of our team. Harbor Health is an entirely new multi-specialty clinic group in Austin, TX utilizing a modern approach to co-create health with those who get, give, and pay for it, allowing everyone to fully flourish. Join us as we build a fully integrated system that connects care to a better payment model that truly puts the human being at the center.

Join Harbor Health as a Health Plan Customer Service Representative to support members and provider inquiries about eligibility, claims, and payer information. This role requires compassion and a commitment to delivering excellent service to those seeking help and guidance. You will collaborate with a supportive team, serve as a resource, and ensure customers and colleagues have a positive experience.
Shifts and Business Hours
This position is full-time (40 hours/week) with flexible shifts available 7 days a week and during our contact center business hours. Business hours are:

Monday - Friday: 6:00am - 8:00pm CT
Saturdays - 8:00am - 5:00pm CT
Sundays - 9:00am - 12:00 CT

Weekday shifts are typically 8 hours. Weekend shifts require a minimum of 4 hours if you are flexing some of your 40 hours outside of the weekday shifts. Your manager will partner with you to determine the shifts that work for you. If there is a business need, there may be opportunities to work overtime.
Training & Resources
During the first two weeks on the job, Harbor will provide formalized training on systems and specific payer topics to help you succeed in this role. Other on-the-job training will take place during normal business hours.
Responsibilities:

Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e., benefit and eligibility, billing and payments, authorizations for treatment and explanation of member benefits (EOBs) and provider payments (EOPs).

Serve as a resource for other team members or health plan customers.
Respond to callers in a friendly and supportive manner with informed responses and next steps.

Document call disposition and notes with accuracy and completeness within the system of record.
Be an active and empathetic listener, ask appropriate questions to identify the primary reason for the call to provide an accurate and complete response.
Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member.
Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues.
Meet the performance goals established for the position in the areas of efficiency, call quality, provider satisfaction, first call resolution and attendance.

Handle protected health information (PHI) with strict confidentiality and diligence, adhering to all privacy protocols and HIPAA regulations.

Identify improvement opportunities within the Call Center process.
Strong verbal and written communication skills.

You will receive rewards and recognition for your performance in a challenging environment that offers clear guidance for success in your role, as well as opportunities to develop skills for other roles you might be interested in.
Required Qualifications:

High School Diploma / GED
1+ year of customer service call center experience with a payer
Familiarity with computer and Windows computer applications, which includes the ability to learn new and complex computer system applications.
Familiarity with payer healthcare terminology and documents (EOP/EOB/ID Cards).
1+ year experience with healthcare claims and/or eligibility data including billing and care management information.

Preferred Qualifications:

Prior experience with processing healthcare claims or enrollment data.
Experience using a Call Center and Tracking system.
Experience with supporting IFP and/or Commercial paper insurance products
Knowledge of MS tools in particular Excel
Bilingual (Spanish) proficiency
Associates degree

Soft Skills:

Ability to multi-task duties as well as the ability to understand multiple products and multiple levels of benefits within each product.
Strong verbal and written communication skills

Ability to manage stressful situations and stay calm to resolve a caller’s issue.

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