Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
At Central Health Plan, a Bright HealthCare company, our Customer Service Representative will assist and respond to all Medicare (to include MAPD and DSNP) members’ requests, questions, and concerns in a timely and professional manner; to function as a liaison/service coordinator between Central Health Medicare Plan, members, and contracted IPAs/providers when applicable.
Duties and Responsibilities:
- Be at work/cubicle timely based on the work schedule on file and ready to handle incoming customer calls and assignments professionally; must follow company and department guidelines for all time off/vacation/overtime requests, especially during enrollment season
- Provide general telephone customer service assistance to both MAPD and DSNP members and providers in a professional manner and provide precise and timely responses;
- Inform Member Services Supervisor on any questions or issues encountered over the phone with members, and any/all member questions or operation related questions before supervisory personnel provide further direction
- Assist with contacting/faxing provider offices when appropriate as part of the general assistance
- Check all voicemail and emails timely
- Write detailed and precise member phone log for each call received and called out and all department assigned functions which require documentation; select the appropriate call category accurately and ensure the consistency of all call log entries; notify any supervisory personnel when help is needed
- Assist with member enrollment and disenrollment outbound contact/research and maintenance of member files, hard copy and all telephone communication must be kept in system and in member file.
- Coordinate the assembling and mailing of welcome packets, ID cards, and all other applicable letter/notices to members when is needed
- Identify and research issues and requests of current members. Communicate both verbally and in writing in a clear and concise manner based on the current policies and guidelines of CMS and Central Health Medicare Plan.
- Assist with D-SNP member calls as appropriate; CHMP CSR guides DSNP members via telephone when necessary to contact his/her social worker or Medi-Cal
- Plans (FFS or HMO managed care) and provides all available resources such as toll free numbers for local SSA office, Medi-Cal offices, and other community contact phone numbers; CSRs do not assist with share of cost issues, balance billing, or eligibility reinstatement directly but if necessary, CSR can assist DSNP members via
- 3-way call to appropriate entities to receive additional assistance.
- Responsible for the intake of member grievances, appeals, coverage determination (including pharmacy), and general complaints expressed verbally or in writing;
- Coordinate with the handling Level 3 Coordinator and/or Member Services
- Supervisor in ensuring the timely filing of all cases. Carefully document and file the receipt of issues and action (s) taken from all responsible parties; Follow up of each grievance/appeal/determination case with QM Department until cases reach resolution/closure; Contact member and provider regarding Plan’s decision on requests/issues when applicable
- Be familiar with Department P & P, Plan benefits, internal guidelines, applicable
- CMS regulatory references, and other applicable department resources provided by supervisory and management personnel; attend all in service and training sessions provided in house and be able to demonstrate good understanding of all such training
- Responsible to complete and handle assigned logs, tasks, member related surveys, and assist with all department projects as needed
- Assist Community Outreach and Education Department and Wellness Centers with event RSVP and other assignments as needed, including attending off site member orientation or member presentation
- Develop a working relationship with the other departments within the organization
- Cooperate with supervisory and management personnel on all auditing related criteria, department policies and guidelines, and implement changes when needed to achieve department goals
- Must have at least High School diploma
- Bilingual and fluent in Mandarin and/or Cantonese - required, language will be tested for fluency
- Previous experience in customer service preferred
- Computer skills to include word processing and excel
- Must have strong verbal, written, and interpersonal communication skills
- Must have excellent customer service skills and demonstrate respect, patience, and helpfulness with customers and co-workers
- Must be responsible, detail-oriented, and professional
- Must understand and comply with HIPAA (patient privacy) regulations
- Prior experience in a customer service environment and/or familiarity with the medical/healthcare industry is preferred but not required
- Must be eligible to work in the U.S.
We’re Making Healthcare Right. Together.
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.