Call Center Representative

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem‑solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Call Center Representative to join our growing team. Job Summary: This Call Center Representative is a front‑line service position aiding Wyoming Benefits Management System and Services (WY BMS) members and providers regarding programs, policies, and procedures. Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the administration of intake documentation into the appropriate systems. Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call. Performance expectations are to meet or exceed operations production and quality standards. This position is located in Cheyenne, Wyoming. Responsibilities: Available to work from 7:00 AM to 6:00 PM Mountain Time on all State business days, Monday through Friday (excluding Wyoming State holidays) Accurately respond to inbound phone calls and process provider and member inquiries and requests into the appropriate system and database Under general supervision resolve customers' service or billing complaints by demonstrating sound judgement Contact customers to respond to complex inquiries or to notify them of claim investigation results and any planned adjustments Under general supervision resolve customer administrative concerns as the first line of contact – this may include claim resolutions and other expressions of dissatisfaction Refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation Keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken Actively listen and probe callers in a professional and timely manner to determine purpose of the calls Under general supervision research and articulately communicate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality Assume full responsibility for self‑development and career progression; proactively seek and participate in ongoing training sessions (formal and informal) Educate providers on how to submit claims and when/where to submit a treatment plan Under general supervision perform necessary follow‑up tasks to ensure member or provider needs are completely met Support team members and participate in team activities to help build a high‑performance team Thoroughly documents customers' comments/information and forwards required information to the appropriate staff Escalate calls to Call Center Lead when necessary Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules Qualifications Required Qualifications/Experience: High School graduate or GED At least 1 year of customer service‑related experience Previous experience with computer applications, such as Microsoft Word and PowerPoint Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills Must be able to maneuver through various computer platforms while verifying information on all calls Must be flexible in scheduling and comfortable with change as customer service is an ever‑changing environment Preferred Qualifications/Experience: Bilingual Spanish speaking Call center experience Healthcare industry experience Medicaid experience Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay range for this position is listed below. Pay Range USD $15.46 - USD $19.33 /Hr. EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. #J-18808-Ljbffr