Description & Requirements
- 🌟 Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
- 🏝️ Paid Time Off Package - Enjoy PTO, Holidays, and sick leave.
- 🌱 Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
- 🏆 Recognition Platform - Acknowledge and appreciate outstanding employee contributions.
- 📚 Tuition Reimbursement - Invest in your ongoing education and development.
- 🎁 Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.
Essential Duties and Responsibilities:
- Interface with and refer complaints and/or inquiries to the appropriate departments, agencies, advocates, and/or client representatives.
- Maintain updated knowledge of managed care as it relates to client supported programs.
- Meet the established processing guidelines, protocols and contract requirements related to complaint processing and the handling of PHI/PII.
- Assist consumers in enrolling, disenrolling, and transferring into health plans, when appropriate.
- Perform other duties as may be assigned by the Complaint Unit Supervisor and/or Project Management.
- Meet all standards established for this position as outlined in the corresponding annual performance criteria and bonus template for this position.
- High school diploma or GED required and 1+ years of relevant professional experience required, or equivalent combination of education and experience.
- Must be fluent in English and specified secondary language.
- Handles more complex customer service inquiries and problems via telephone, recording consistent problem areas.
- May respond to email inquiries.
- Customer service is the primary function.
- Calls are non-routine and require deviation from standard screens, scripts, and procedures.
- Handles situations which may require adaptation of response or extensive research according to customer response.
- Uses computerized system for tracking, information gathering, and/or troubleshooting.
- May handle escalated or unresolved calls from less experienced representatives.
- Works on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understands implications of work and makes recommendations for solutions.
- Required to travel within the region assigned
- High School diploma, GED, or equivalent certification
- DSHS Community Health Worker certification preferred.
- One year of human services experience or experience dealing with the public.
- Proficient in Microsoft Office products.
- Knowledge of Excel required.
- Ability to work with customers in a caring and respectful manner and with due understanding of and consideration for their unique circumstances.
- Excellent organizational, written, and verbal communication skills.
- Ability to perform comfortably in a fast-paced, deadline-oriented work environment.
- Must be able to remain in a stationary position for an extended period of time.
- Occasionally lifts, carries, or otherwise moves items weighing up to 25 pounds.
- Work is often performed conducting home visits, presentations, and part in an office environment.
- Reliable transportation with proper insurance and a Texas Driver’s License that meets the State of Texas requirements.
- Medicaid knowledge preferred