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OmniCare365 · 2 weeks ago

Customer Service Representative (Healthcare)

United States

Full-time

Remote

Entry Level

$15/hr - $15/hr

1+ years exp

OmniCare365 is a trusted outsource customer care company that focuses on providing exceptional brand value through customer experiences. The Customer Service Representative role involves scheduling health risk assessment appointments and advocating for members' healthcare needs in a compassionate manner.

Customer ServiceOutsourcingTelecommunications

Responsibilities

Advocate for the member and/or caller by making the interaction hassle-free. Some examples would include contacting providers, pharmacies, or ancillary providers

Compassionately own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member

Effectively ensures members are connected to appropriate specialists and/or enrolled in the correct programs, based on member’s needs and eligibility

Demonstrate knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision)

Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, OTC, HRA,)

Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements)

Maintain knowledge of information/process changes due to healthcare reform by referring to applicable company resources (e.g., dependent age, removal of lifetime limits, free preventive care services, Loss of Medicaid)

Demonstrate knowledge of established workflows and support processes (e.g., available resources, Medicaid state specifics)

Identify inaccurate/inconsistent information found in systems/tools and communicate to appropriate resources

Communicate common problems/questions presented by callers to appropriate Subject Matter Experts to drive continuous improvement

Educate callers on self-service resources available to them and on their responsibilities regarding their health care coverage

Refer members/callers to other resources applicable to their questions/issues where appropriate (e.g., pharmacists, prior authorizations, billing department, transportation, etc.)

Compassionately educate members about the fundamentals of health care benefits including: Managing health and well being

Offer Next Best Actions on account and follow up appropriately

Assist members in appointment scheduling to proactively address gaps in care

Provider education and choosing a quality care provider

Maximizing the value of their health plan benefits

Research complex issues across multiple applications and work with support resources to resolve customer issues

Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution, compliance, customer follow-up, and attendance

Complete follow up with member as appropriate

Qualification

Healthcare terminologyBenefit interpretationCall center experienceBilingual (English/Spanish)Problem-solving skillsEmpathyCompassionConflict managementCommunication skillsAttention to detailTime management skills

Required

High school diploma or GED is acceptable

1+ years in a Call Center environment required

Demonstrated ability to display empathy and compassion throughout every interaction

Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner and delivering on commitments)

Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member

Ability to overcome objections and persuade members to take action / change behavior

Ability to utilize multiple systems/platforms while on a call with a member – strong computer skills and technical aptitude

Proficient problem-solving approach to quickly assess current state and formulate recommendations

Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon

Flexibility to customize approach to meet all types of member communication styles and personalities

Excellent conflict management skills including: Professionally and adeptly resolve issues while under stress, Diffuse conflict and member distress, Demonstrate personal resilience

Strong verbal and written communication skills

Solid time management skills

Strong attention to detail

Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed

Preferred

Experience in Health Care/Insurance environment preferred (familiarity with medical terminology, health plan documents, claims, or benefit plan design are examples)

Bi-lingual candidates desired (English/Spanish)