Senior Call Center Representative - Member Services

About the role

We are searching for a Senior Call Center Representative who works well in a fast-paced setting. In this position, you will serve as a member and/or provider advocate, understanding the organization's processes, policies, and procedures to investigate, resolve, and/or facilitate the resolution of simple to complex issues or questions. You will be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals, and any other member/provider demands. You will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling.

Responsibilities

• Act as a secondary resource to Call Center Representatives in the absence of the Team Lead and respond to escalated calls, triaging to management if necessary.
• Identify and handle a variety of routine to complex customer or prospect inquiries or requests.
• Educate members about their health coverage benefits and services, empowering members/providers by directing them toward available resources for self-help.
• Meet Senior Member Service Representative performance goals for customer satisfaction, quality, productivity, and all performance metrics.
• Ensure all HIPAA and state privacy and confidentiality requirements/regulations are adhered to at all times.
• File complaints and appeals on behalf of members and providers within the regulatory timeframe and in compliance with departmental policies and procedures.

Requirements

• High school diploma or GED.
• Minimum of 3 years of customer service, call center, and/or experience within managed care or insurance industry.
• A Bachelor's degree may substitute for two (2) years of the required experience.

About Us

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children, and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.