Customer Engagement Representative 2

Nature and Scope

This position works in a fast-paced environment using various modes of communication including face-to-face, video conferencing, telephone, chat, messaging, and email. Representatives must be able to master systems and technology associated with the role and be comfortable working efficiently while multitasking. Excellent interpersonal skills are required to understand customer inquiries or complaints and manage through potential difficult conversations. Representatives must maintain this level of service while working with complex situations and high volumes.

• Answering and routing of high volume of inbound/outbound interactions through multiple channels and computer software systems.
• Communicating with customers to resolve inquiries using various platforms.
• Coordinating healthcare services including appointment scheduling, updating patient records, obtaining authorizations, communicating with care teams, arranging transportation, paging on-call physicians, escalating patient concerns, general compliant and grievance resolution, basic navigation of the healthcare system, providing technical support, and payment collection.

Responsibilities

• Provide excellent service utilizing basic knowledge of all services supported for Hometown and Renown Health.
• Follow established standard policies and procedures to complete pertinent tasks, meet customer needs, and work for one call resolution.
• Communicate with customers to resolve inquiries using various platforms.
• Coordinate healthcare services including appointment scheduling, updating patient records, obtaining authorizations, communicating with care teams, arranging transportation, paging on-call physicians, escalating patient concerns, general compliant and grievance resolution, basic navigation of the healthcare system, providing technical support, and payment collection.
• Provide appropriate responses to its customers and consumers regarding Plan benefits to include, but not limited to eligibility, benefit quoting, provider network, referral and authorization process, claims payment, as well as policies and procedures.
• Work effectively with professionals across the health system including providers, social workers, case managers, nurses, medical assistants, patient access representatives, insurance companies, and other third parties.
• Handle inquires related to compliance and regulatory auditing.
• Information intake and analysis to determine appropriate level of care and priority.
• Schedule advanced modalities or highly specialized appointments for consultations, exams, and procedures.
• Cookordinate with appropriate care team (internal & external) to ensure seamless patient experience and timely resolution of all patient needs.
• Perform service recovery to retain positive customer relationships and utilization of the health system to retain and promote customer loyalty.
• Utilize judgement and discretion to complete pertinent tasks, meet customer needs, and work for one call resolution.
• Be able to use critical thinking and creative solutions when established policies and procedures fail.
• Able to work through and resolve complex claims and payment processes.

Qualifications

• Must have working-level knowledge of the English language, including reading, writing and speaking English.
• A college degree or equivalent experience is preferred by not required.
• Successful completion of Customer Engagement Representative 1 OR 2-3 years of experience in customer service, healthcare, or health insurance with demonstrated competence within 90 days of hire.
• Required to have strong customer services skills.
• Ability to speak Spanish desired.
• Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, teams, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
• Ability to type average of 40 WPM.
• Experience with electronic medical record systems is a plus.