Quick overview
Job description
At Texas Children’s Hospital, our mission starts with our people. Guided by our HEART values—Humility, Excellence, Accountability, Respect, and Trust—we strive to create a workplace where teammates feel valued, supported, and empowered to do their best work every day. As a Senior Call Center Representative, you will serve as a member and/or provider advocate that understands the organization's processes, policies, and procedures to investigate, resolve and/or facilitate the resolution of simple to complex issues/questions. 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.
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