Contact Center Specialist - Southwestern Health Resources
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- United States
- Work type
- Hybrid
- Posted
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Contact Center Specialist - Southwestern Health Resources
Southwestern Health Resources is looking for a highly skilled Contact Center Specialist. Is that you?
Work Location: Southwestern Health Resources Headquarters, Hybrid: 1601 Lyndon B. Johnson Freeway, Farmers Branch, TX 75234.
Work Hours: Full Time Days (8:00am-5:00pm) for 40 hrs/week (remote work allowed at manager's discretion)
Department Highlights:
- Hybrid Position
- Gain a sense of accomplishment by contributing to a teamwork environment.
- Receive excellent mentorship, comprehensive training, and dedicated leadership resources.
- Contribute and work on a cross functional team
What You Will Do:
Responds promptly to telephone calls and digital or emailed contacts from brokers, employers, healthcare providers, and plan members. Provides resolution or follow-up or appropriately routes or escalates each inquiry, issue, or request received. 20%
Assists employers, healthcare providers, and plan members with appointment and scheduling requests, authorization and referral support, benefits navigation, network provider searches, primary care physician (PCP) assignments, research and resolution of billing inquiries, and community resources referrals. 20%
Accurately and thoroughly documents all telephonic, digital, email, written, and in-person interactions per department protocol. 20%
Assists employers, healthcare providers, and plan members with the satisfactory and speedy resolution of all fulfillment requests as assigned. 15%
Supports other organization departments with patient referral and intake to clinical programs, healthcare initiatives and wellness programs outreach, quality gap closures, and network adequacy cold call audits. 15%
Performs other duties and special projects as assigned. 10%
What You Need:
Education
Bachelor's Degree Business Admin, Healthcare Admin, or Related Field Req Or
Associate's Degree Business Admin, Healthcare Admin, or Related Field 1 Year Req Or
H.S. Diploma or Equivalent 3 Years Req
Experience
1 Year Healthcare (Health Plan or Health Provider) Customer Service and/or client engagement experience (with Associate's) Req or
3 Years Healthcare (Health Plan or Health Provider) Customer Service and/or client engagement experience (without degree) Req
Skills
Familiarity with various types of commercial and government health care benefit programs, employer group benefit plans, and benefit plan designs.
Able to interpret and explain plan documents such as summaries of benefits and coverage, summary plan descriptions, group and individual policies, certificates of coverage, explanations of coverage, explanations of benefits (EOBs), and plan correspondence.
Working knowledge of provider network arrangements and reimbursement methodologies.
Working knowledge of health benefit plan concepts such as limitations, exclusions, waiting periods, waivers, coordination of benefits, utilization counters, member and plan responsibilities, stop loss, subrogation, authorization and referral requirements, recoveries, and the appeals and grievances process.
Knowledgeable of and compliant with all relevant laws, rules, regulations and requirements regarding health plan operations (ERISA, Department of Labor, HIPAA, Texas Department of Insurance, Centers for Medicare and Medicaid Services (CMS), etc.).
Familiarity with Microsoft Office: Excel, Outlook, and Word
Strong attention to detail with good analytical, proofing, problem solving, organizational, multitasking, and time management skills.
Self-motivated with confident decision-making abilities; able to focus in a fast-paced environment.
Demonstrates good verbal and written communication skills.
Shows good customer service and interpersonal skills.
ADA Requirements
Working Indoors 67% or more
Physical Demands
Sedentary
- Location: Dallas, Texas, United States
- Job Field: Clerical/Admin
- Travel: No
- Shift: Day Job
- Schedule: Full-time
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