Customer Service Rep II

Who we are

About the Role

This position is part of a team of representatives who respond to member and provider inquiries regarding benefits, eligibility, status of claims, and other related issues to provide information and facilitate and/or coordinate appropriate resolutions.

To be successful in this role, you: 

• Are committed to serving the underserved community and treating others with respect, courtesy, and maintaining member confidentiality.
• Have experience with state and federal programs (Washington Apple Health, Medicare Advantage Plans.
• Are knowledgeable of medical terminology and healthcare.
• Have a desire to be part of a collaborative, ever evolving, dynamic team.
• Have a minimum of three (3) year of call center experience preferably in insurance, managed care, or from a provider setting.
• Comfortable working in a 100% remote environment.

Essential functions and Roles and Responsibilities: 

• Provide first call resolution by responding accurately and courteously to member and provider inquiries regarding benefit interpretation, eligibility, claims status, accessing care through plan providers and other related issues under Washington Apple Health, Medicare Advantage, and Cascade Select Plans and other products as offered by Community Health Plan of Washington.
• Document inquiries, complaints, and other data in computer database in an accurate, clear, and timely manner.
• Provides support to CHPW members during the Medicare Annual Election Period with includes working a variable shift and or weekend hours.
• Advises providers with the outcome of how a claim has processed and takes appropriate action on behalf of the provider and CHPW.
• Meet attendance and call quality standards.
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion

Knowledge, Skills, and Abilities: 

• Ability to gather and assess information from multiple systems, apply protocols, and determine appropriate actions.
• Ability to use MS office products such as Outlook, Word, and Excel.
• Knowledge of claims and claims processing.
• Knowledge of medical terminology and healthcare.
• Excellent verbal and written communication skills, including typing.
• The ability to summarize calls notes and create clear and concise documentation.

As part of our hiring process, the following criteria must be met: 

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Non-Exempt and is eligible for overtime. Based on market data, this position grade is (38) (see full range below) and has a (5%) annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents: 

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.

Mental:  

• Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.