Description & Requirements
- π Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
- ποΈ Paid Time Off Package - Enjoy PTO, Holidays, and sick leave.
- π± Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
- π Recognition Platform - Acknowledge and appreciate outstanding employee contributions.
- π Tuition Reimbursement - Invest in your ongoing education and development.
- π Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.
Essential Duties and Responsibilities:
- Interface with clients and refer complaints or inquiries to appropriate departments, agencies, advocates, or client representatives.
- Stay updated on managed care relevant to supported client programs.
- Adhere to processing guidelines, protocols, and contract requirements for complaint processing and handling PHI/PII.
- Assist consumers in health plan enrollment, disenrollment, and transfers when necessary.
- Fulfill assigned duties directed by the Complaint Unit Supervisor or Project Management.
- Meet performance standards outlined in the annual criteria and bonus template for the position.
- Address complex customer service inquiries and problems over the telephone, noting consistent issues for resolution.
- Potentially respond to email inquiries.
- Prioritize customer service as the primary function, handling non-routine calls requiring deviation from standard procedures.
- Manage situations needing adapted responses or extensive research based on customer needs.
- Utilize computerized systems for tracking, information gathering, and troubleshooting.
- Handle escalated or unresolved calls from less experienced representatives.
- Tackle moderately difficult assignments, exercising judgment in issue resolution and recommending solutions.
- High school diploma or GED required and 1+ years of relevant professional experience required, or equivalent combination of education and experience.
- 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 Driverβs License that meets the State of Texas requirements.
- Highly developed problem-solving skills preferred.
- Demonstrated ability to build high-performing teams preferred.
- Medicaid knowledge preferred