Healthcare Customer Service Representative Community Health Worker

We are currently hiring a Healthcare Customer Service Representative ! If you are a great communicator compassionate enjoy a fast-paced work environment and value being part of a team that makes a difference you may be the right person for the position! Apply today!

Classification: NON-EXEMPT Status & Schedule: FULL-TIME MONDAY FRIDAY 8AM 5PM
Location: ONSITE this position reports to the Coos Bay Office location

Salary: $18.54 - 25.75$/HOURLY
Department: MEMBER SERVICES Reports to: CUSTOMER SERVICE MANAGER Supervision Exercised: NON-SUPERVISORY

Job Purpose: Customer Service Representative

Responsible for maintaining a customer-oriented approach while ensuring that designated health plan members receive information and direction for covered OHP benefits including medical behavioral dental non-emergent transportation and substance use care and support necessary to meet their needs. This position provides support to health plan members and providers; serves as a resource for staff and community medical personnel and responds to requests for coordinated care information.

Qualifications Education & Experience

• Minimum High School Diploma or GED; Associate degree in business administration preferred
• Minimum two years experience in a medical office clinic or healthcare administration setting and two years experience in customer service-related position
• THW Certification preferred or willing to obtain - Must reside in Oregon
• Bilingual preferred qualified certified or willing to obtain

Essential Responsibilities: Customer Service Representative

1. Talk with members and providers by phone or in person handling inquires in a prompt courteous manner
2. Greet persons entering the building in a professional manner determine nature and purpose of visit and direct or call appropriate staff member to escort them to specific destinations
3. Provide information to guests members and the public answer questions with discretion and tact
4. Facilitate the resolution of complaints from customers members and/or the public escalate to appropriate staff member(s) as necessary
5. Act as a member advocate and liaison with providers and partners as needed to ensure members are connected to services
6. Receive inquiries and route any issues to the appropriate person or department for resolution responding in a timely manner and documenting the action taken
7. Understand plan eligibility benefit package and claims payment requirements
8. Research verify and resolve inquiries relating to Oregon Health Plan and Advanced Health eligibility
9. Outreach members by phone to complete Health Risk Assessments
10. Complete tracking and status reports
11. Use current technology and software to document all activities from any mode of communication from members providers and other customers
12. Assist with the preparation and mailing of letters notices member handbooks flyers etc. as directed
13. Receive and send packages
14. Compose type and edit correspondence reports memoranda and other material as assigned
15. Ensure that the lobby is clean and kept free from clutter; report if windows floors walls furniture etc. need cleaning or repair
16. Assist with other related clerical and administrative duties as assigned
17. Participate in quality and organizational process improvement activities and teams when requested
18. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
19. Handle confidential information and materials appropriately and maintain a secure work area
20. Other duties as assigned

Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER

• Participate in quality and organizational process improvement activities when requested
• Support and contribute to effective safety quality and risk management efforts by adhering to established policies and procedures maintaining a safe environment promoting accident prevention and identifying and reporting potential liabilities
• Openly clearly and respectfully share and receive information opinions concerns and feedback in a supportive manner
• Work collaboratively by mentoring new and existing co-workers building bridges and creating rapport with team members across the organization
• Provide excellent customer service to all internal and external customers which includes team members members students visitors and vendors by consistently exceeding the customers expectations
• Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
• Advance personal knowledge base by pursuing continuing education to enhance professional competence
• Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
• Represent organization at meetings and conferences as applicable

Knowledge Skills & Abilities:

• Critical attention to detail for accuracy and timeliness
• High degree of initiative judgment discretion and decision-making
• Ability to exercise sound clinical judgment independent analysis critical thinking skills and knowledge of health conditions to determine best outcomes for members
• Ability to report to work as scheduled and willingness to work a flexible schedule when needed
• Proficient in Microsoft Office Suite and Windows Operating System (OS)
• Training in or awareness of Health Literacy Poverty Informed Systemic Oppression language access and the use of healthcare interpreters uses of data to drive health equity Cultural Awareness Trauma-Informed Care Adverse Childhood Experiences (ACEs) Culturally and Linguistically Appropriate Service (CLAS) Standards and universal access
• Knowledge and understanding of how the positions responsibilities contribute to the department and company goals and mission
• Knowledge of federal and state laws including OSHA HIPAA Waste Fraud and Abuse
• Awareness and understanding of equity diversity inclusion and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social political and environmental contexts of policies programs and practices
• Excellent people skills and friendly demeanor
• Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems
• Attention to detail and organization skills
• Ability to handle stress and sensitive situations effectively while projecting a professional attitude
• Ability to communicate professionally both conversing and written
• Ability to work with diverse populations and interact with people of differing personalities and backgrounds
• Sensitive to economic considerations human needs and aware of how ones actions may affect others
• Ability to organize and work in a sensitive manner with people from other cultures
• Poised; maintains composure and sense of purpose

Working Conditions:

This position must have the ability to remain in a stationary position occasionally move about inside the office to access office machinery printer etc. frequently communicate and exchange accurate information.

Work Condition: Onsite work
Employee generally works within the interior of an office.
Employee may travel locally and be responsible for own transportation. Out of area travel may be required on occasion.
Hours of operations and specific staff scheduling may vary based on operational need.
The office environment is clean with a comfortable temperature and moderate noise level.
Exposed to: Cold/heat controls close contact with employees and the public in office environment.
Machines equipment tools and supplies used: Constantly operates a computer or other office productivity machinery such as postage machine fax copier calculator multi-line telephone system scanner
May answer a high volume of telephone calls complete documentation and use computer programs to either obtain or record information.
Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.

Other Information:

This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of DOCS Management Services employees. Other duties responsibilities and activities may change or be assigned at any time with or without notice.

Required Experience:

Unclear Seniority