Call Center Representative-Health Plan (NM Residents Only)
About the position
The Call Center Representative for the Health Plan is responsible for providing exceptional customer service to members and providers regarding various PHP benefit plans. This role involves responding to inquiries through multiple channels, ensuring that callers receive accurate information and support. The position emphasizes the importance of diversity and inclusion within the team and community, highlighting the organization's commitment to improving health outcomes for its members.
Responsibilities
Responds to questions or issues from PHP members and providers about insurance benefits, coverage, or premiums.
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Respond to incoming calls routed through skill-based technology to meet quality standards and performance measurements.
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Develop and maintain positive customer or partner relationships, acting as a member/patient advocate.
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Participates and represents PHS/PHP in outreach events such as enrollment fairs and health fairs.
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Assists in the development of documentation of process and procedures into functional process improvements.
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Researches inquiries/special projects as requested and responds to customer, partner or other PHS/PHP business units.
Requirements
High school diploma plus one to three years of office/business experience; call center experience preferred.
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Claims processing experience in managed care with possible enrollment experience is preferred.
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Demonstrated ability to communicate effectively in person and via telephone with various stakeholders.
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Written communication skills as well as business writing and presentation skills are required.
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Requires strong organizational skills and the ability to create, sort, and analyze reports.
Nice-to-haves
Experience in managed care claims processing.
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Knowledge of reimbursement methodologies such as DRG, Relative Value Systems, Per Diem, Fee schedule.
Benefits
Medical insurance
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Dental insurance
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Vision insurance
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Short-term and long-term disability
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Group term life insurance
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Paid time off
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Wellness program rewards
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Retirement benefits
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