Call Center Rep

Heritage Healthcare - Brea, CA (30+ days ago)3.5


Job Summary:
Under the direction of the Supervisor, Call Center, the Customer Service Representative supports the Call Center Team and internal departments by advocating on behalf of members, and helps them navigate through the managed care system. This position is responsible for the resolution of customer enquiries through multiple channels; data entry to maintain computer systems; upkeep of resources to remain current; and coordination of special projects and events.

Essential Values-Based, Leadership and Management Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.

Dignity: Demonstrates competence in communication and interpersonal relations.

Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork.

Service: Demonstrates competence in customer/patient focus and adaptability.

Justice: Demonstrates competence in community orientation and stewardship.

As defined on the attached Values-Based Competency Model Form.

Essential Functions:
  • Handles intake of multiple phone lines using established scripts, protocols and service processes. Responds to each call in an efficient, effective, and professional manner.
  • Accurately tracks and enters calls using appropriate documentation, reporting, and database applications. Assists with maintaining department databases and resource tools.
  • Notifies members of urgent approvals and denials within appropriate time frames, per guidelines set. Coordinates communication and patient services with Utilization Management Team.
  • Functions as a liaison between internal departments and members regarding referral status, authorizations, eligibility, patient portal registration, physician information, and complaint resolution. Troubleshoots operational and technical issues.
  • Interacts with multiple departments, e.g., Resource Management, I.S., Provider Relations, Utilization Management, Claims, and Eligibility to provide resolution to patient and health plan/vendor enquiries. Supports positive internal relations and communication across all areas.
  • Understands and uses proper procedures to resolve problems, escalate issues, and achieve objectives in a productive and cooperative manner. Provides timely feedback about processes to improve caller experiences and satisfaction.
  • Supports overall department operations through cooperation and teamwork.
Additional Responsibilities:
  • Provides assistance to the supervisor as needed.
  • Assists with specialized reporting and research projects.
  • Performs other duties as assigned.
Knowledge / Skills / Abilities:
  • Excellent verbal, written, and interpersonal communication skills to communicate effectively with individuals at all levels of the organization.
  • Ability to provide stellar service using excellent advocacy skills and telephone etiquette to build loyalty, extend customer retention, and satisfy corporate goals and objectives.
  • Approaches each customer interaction with professionalism, compassion and empathy.
  • Ability to work in a fast-paced department and maintain a high level of productivity.
  • Successfully handles a high call volume with frequent interruptions.
  • Possess critical-thinking and problem-resolution skills.
  • Excellent follow through skills, responding timely to phone calls, tasks, and projects; accuracy and attention to detail are a must.
  • Possess excellent organizational and time management skills.
  • Ability to prioritize and handle multiple tasks effectively, remain flexible, and adapt to shifting work demands.
  • Must be able to work under general supervision.
  • Able to work independently, but also as a team player. Supports and promotes intra- and inter-departmental teamwork, exhibiting a spirit of cooperation.
  • Present a professional and mature demeanor.
  • Display patience and demonstrates respect for callers and staff. Recognizes diversity of customers and is accepting of individual differences, beliefs and values.
Minimum Position Qualifications:
Education:
  • High School Diploma or equivalent required.
Experience:
  • Requires two (2) year’s experience in a customer service environment.
Computer Skills:
  • Able to navigate through PC applications. Basic MS Windows, Excel, Word, and Outlook knowledge and experience required.
Knowledge / Skills / Abilities:
  • Excellent verbal, written, and interpersonal communication skills to communicate effectively with individuals at all levels of the organization.
  • Ability to provide stellar service using excellent advocacy skills and telephone etiquette to build loyalty, extend customer retention, and satisfy corporate goals and objectives.
  • Approaches each customer interaction with professionalism, compassion and empathy.
  • Ability to work in a fast-paced department and maintain a high level of productivity.
  • Successfully handles a high call volume with frequent interruptions.
  • Possess critical-thinking and problem-resolution skills.
  • Excellent follow through skills, responding timely to phone calls, tasks, and projects; accuracy and attention to detail are a must.
  • Possess excellent organizational and time management skills.
  • Ability to prioritize and handle multiple tasks effectively, remain flexible, and adapt to shifting work demands.
  • Must be able to work under general supervision.
  • Able to work independently, but also as a team player. Supports and promotes intra- and inter-departmental teamwork, exhibiting a spirit of cooperation.
  • Present a professional and mature demeanor.
  • Display patience and demonstrates respect for callers and staff. Recognizes diversity of customers and is accepting of individual differences, beliefs and values.
Preferred Position Qualifications:
Experience:
  • Previous experience in a healthcare setting.
  • Customer service experience in a managed care environment highly desirable.
Computer Skills:
  • IDX experience is a plus.
Other:
  • Medical Terminology knowledge.
  • Bilingual English/Spanish communication skills.