Customer Care Representative

Job Full Description

The Customer Care Representative position is responsible for providing support to health plan members and providers, serving as a resource for staff and community medical personnel by performing the following duties. The following schedules are available:

• Monday - Friday (Full-Time)
• Monday-Friday (part-time, 24-32 hours)

Essential Duties

• 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.

Job Duties

• 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.

Qualifications


Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Education & Experience

• 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.

Language Skills


Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.


Mathematical Skills


Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability


Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Interpersonal Skills

• 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.

Medford, OR
1951
3523 Arrowhead Drive
Suite 100
Medford, OR 97504