Job Summary: Customer Service Representative I will assist Medicaid and Medicare members/providers with benefit, claims, and other inquiries. The CSR I provides quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for timely resolution. CSR’s are also required to capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business. Essential Functions: • Assist members with routine servicing inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances. • Assist a provider with routine servicing inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures. • Ensuring all HIPAA and State requirements/regulations are adhered too at all times, in existing and future lines of business. • Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction. • Build and strengthen member relationships by providing quality customer service. • Maintain knowledge and understanding of all processes and procedures. • Adhere to all departmental and company policies and procedures. • Maintain complete and accurate documentation of all of telephone and written communications. • Act as a mentor to new hire employees. • Screen members to determine Case Management needs, and refer when appropriate. • Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution. • Assist with non phone work such as incoming faxes and web inquires.
Minimum Qualifications: Experience: • Two years customer service experience is preferred • Customer Service experience in a call center is preferred. Technical Skills: • Computer proficiency with knowledge and experience in a “Windows” environment • Typing, 35 WPM Experience: • HMO or related industry experience
Knowledge, Skills, and Abilities: • Strong written and communication skills • Professional phone etiquette • Proper use of grammar • Ability to work in a fast paced environment • Adaptable to a constantly changing environment • Attention to detail • Ability to multitask • Ability to work independently and with a team • Critical thinking and listening skills • Decision making and problem solving skills
Education: • High School Diploma or equivalent
S03 - $11.79
About the Organization
CareSource is the 2nd largest Medicaid managed health care plan in the country, and our strength lies in our experience. CareSource provides a full spectrum of services for the administration of public-sector health care programs, serving more than 900,000 Medicaid consumers in Ohio and Michigan.
Our health plans are founded on the principles of quality and service delivered with compassion and a thorough understanding of Medicaid, Medicare, and the associated regulatory environments. We offer a unique approach to managed care through the process efficiencies and value-added benefits we offer to our members and the health care providers we partner with to serve them. As a managed health care organization, CareSource focuses on prevention with a goal of improving member health and the quality and accessibility of health care services for Medicaid consumers. CareSource assists in the coordination of member care by partnering with a defined network of participating doctors, hospitals and other health care providers.
CareSource is an equal opportunity employer that offers a drug and tobacco free environment and a competitive compensation and benefits package to full-time and part-time employees who work at least 24 hours per week.
The benefits package includes:
• Health, dental and vision insurance
• Flexible spending accounts (health and dependent care)
• Life insurance
• Accidental death and dismemberment insurance
• Short- and long-term disability insurance
• 401(k) retirement plan
• Liberal paid personal time to be used on a discretionary basis for sick leave or as scheduled time off
• Eight paid holidays and a floating holiday
• Educational reimbursement
For more information about CareSource, please see About Us on our website, www.caresource.com.
CareSource - 22 months ago