Location: Houston, TX
Company: Texas Children's Hospital
You will be the first point of contact for assistance or information regarding eligibility, benefits, authorizations, claims, referrals and/or any other member/provider demands. Lastly, you will assist and advocate for members and/or providers throughout the complaint and appeal process and support members with timely appointment scheduling.
Think you've got what it takes? Job Duties & Responsibilities • Act as a secondary resource to Call Center Representatives in the absence of the Team Lead and responds to escalated calls and triages 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 and 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 Skills & Requirements • High school diploma or GED • Minimum of 3 years of customer service, call center, and/or experience within managed care or insurance industry
or • A Bachelor's degree may substitute for two (2) years of the required experience • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children's, unless approved for a medical or religious exemption.
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. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople. org for career opportunities. You can also learn more about our amazing culture at infinitepassion. org. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, interactionual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
Customer service jobs involve assisting customers by providing information, answering questions, and resolving issues with a company's products or services. In this role, employees act as the front line of communication between a business and its clients, ensuring customer satisfaction and loyalty. Characteristics of these positions include strong communication skills, problem-solving abilities, and patience. Customer service representatives must be adept at listening, empathetic to customer concerns, and skilled at offering solutions. They work in various settings, including call centers, retail stores, and online platforms, and their goal is to foster positive experiences to build the company's reputation and customer base.
Customer service jobs involve roles where professionals are dedicated to assisting customers by answering queries, solving problems, and providing information. These positions can range from call center representatives to in-person support staff and may exist across various industries, such as retail, technology, and finance. A key characteristic of customer service jobs is the focus on communication skills, patience, and an ability to resolve conflicts effectively. Employees in these roles often act as the face of a company, striving to ensure satisfactory experiences that contribute to customer retention and loyalty.
Customer service jobs involve assisting customers by providing information, answering questions, and resolving issues with a company's products or services. In this role, employees act as the front line of communication between a business and its clients, ensuring customer satisfaction and loyalty. Characteristics of these positions include strong communication skills, problem-solving abilities, and patience. Customer service representatives must be adept at listening, empathetic to customer concerns, and skilled at offering solutions. They work in various settings, including call centers, retail stores, and online platforms, and their goal is to foster positive experiences to build the company's reputation and customer base.
Customer service jobs involve roles where professionals are dedicated to assisting customers by answering queries, solving problems, and providing information. These positions can range from call center representatives to in-person support staff and may exist across various industries, such as retail, technology, and finance. A key characteristic of customer service jobs is the focus on communication skills, patience, and an ability to resolve conflicts effectively. Employees in these roles often act as the face of a company, striving to ensure satisfactory experiences that contribute to customer retention and loyalty.
