Job Purpose: Customer Service Representative
Responsible for maintaining a customer-oriented approach while ensuring that designated health plan members receive information and direction for covered OHP benefits including medical, behavioral, dental, non-emergent transportation and substance use care and support necessary to meet their needs. This position provides support to health plan members and providers; serves as a resource for staff and community medical personnel and responds to requests for coordinated care information.
Qualifications, Education, & Experience
- Minimum High School Diploma or GED; Associate degree in business administration preferred
- Minimum two years’ experience in a medical office, clinic or healthcare administration setting and two years’ experience in customer service-related position
- THW Certification preferred, or willing to obtain - Must reside in Oregon
- Bilingual preferred, qualified, certified, or willing to obtain
Essential Responsibilities: Customer Service Representative
- Talk with members and providers by phone or in person, handling inquires in a prompt, courteous manner
- Greet persons entering the building in a professional manner, determine nature and purpose of visit, and direct or call appropriate staff member to escort them to specific destinations
- Provide information to guests, members and the public, answer questions with discretion and tact
- Facilitate the resolution of complaints from customers, members, and/or the public, escalate to appropriate staff member(s) as necessary
- Act as a member advocate and liaison with providers and partners as needed to ensure members are connected to services
- Receive inquiries and route any issues to the appropriate person or department for resolution, responding in a timely manner and documenting the action taken
- Understand plan eligibility, benefit package and claims payment requirements
- Research, verify and resolve inquiries relating to Oregon Health Plan and Advanced Health eligibility
- Outreach members by phone to complete Health Risk Assessments
- Complete tracking and status reports
- Use current technology and software to document all activities from any mode of communication from members, providers and other customers
- Assist with the preparation and mailing of letters, notices, member handbooks, flyers, etc. as directed
- Receive and send packages
- Compose, type and edit correspondence, reports, memoranda and other material as assigned
- Ensure that the lobby is clean and kept free from clutter; report if windows, floors, walls, furniture, etc. need cleaning or repair
- Assist with other related clerical and administrative duties as assigned
- Participate in quality and organizational process improvement activities and teams when requested
- Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
- Handle confidential information and materials appropriately and maintain a secure work area
Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER
- Participate in quality and organizational process improvement activities when requested
- Support and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
- Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
- Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
- Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
- Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
- Advance personal knowledge base by pursuing continuing education to enhance professional competence
- Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
- Represent organization at meetings and conferences as applicable
Knowledge, Skills, & Abilities:
- Critical attention to detail for accuracy and timeliness
- High degree of initiative, judgment, discretion, and decision-making
- Ability to exercise sound clinical judgment, independent analysis, critical thinking skills, and knowledge of health conditions to determine best outcomes for members
- Ability to report to work as scheduled, and willingness to work a flexible schedule when needed
- Proficient in Microsoft Office Suite and Windows Operating System (OS)
- Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
- Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
- Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
- Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
- Excellent people skills and friendly demeanor
- Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
- Attention to detail and organization skills
- Ability to handle stress and sensitive situations effectively while projecting a professional attitude
- Ability to communicate professionally, both conversing and written
- Ability to work with diverse populations and interact with people of differing personalities and backgrounds
- Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
- Ability to organize and work in a sensitive manner with people from other cultures
- Poised; maintains composure and sense of purpose
Working Conditions:
This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.
Work Condition: Onsite work
Employee generally works within the interior of an office.
Employee may travel locally and be responsible for own transportation. Out of area travel may be required on occasion.
Hours of operations and specific staff scheduling may vary based on operational need.
The office environment is clean with a comfortable temperature and moderate noise level.
Exposed to: Cold/heat controls, close contact with employees and the public in office environment.
Machines, equipment, tools, and supplies used: Constantly operates a computer or other office productivity machinery, such as postage machine, fax, copier, calculator, multi-line telephone system, scanner
May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information.
Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on task.
Other Information:
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
