Customer Service Rep I

at  Community Health Plan of Washington

WHO WE ARE

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Knowledge, Skills, and Abilities:

• Ability to gather and assess information from multiple systems, apply protocols, and determine appropriate actions.
• Ability to use MS office products such as Outlook, Word, and Excel.
• Knowledge of claims and claims processing.
• Knowledge of medical terminology and healthcare.
• Excellent verbal and written communication skills, including typing.
• The ability to summarize calls notes and create clear and concise documentation

This position is part of a team of representatives who respond to member and provider inquiries regarding benefits, eligibility, status of claims, and other related issues to provide information and facilitate and/or coordinate appropriate resolutions.

To be successful in this role, you:

• Are committed to serving the underserved community and treating others with respect, courtesy, and maintaining member confidentiality.
• Have experience with state and federal programs (Washington Apple Health, Medicare Advantage Plans.
• Are knowledgeable of medical terminology and healthcare.
• Have a desire to be part of a collaborative, ever evolving, dynamic team.
• Have a minimum of three (3) year of call center experience preferably in insurance, managed care, or from a provider setting.
• Comfortable working in a 100% remote environment.

Essential functions and Roles and Responsibilities:

• Provide first call resolution by responding accurately and courteously to member and provider inquiries regarding benefit interpretation, eligibility, claims status, accessing care through plan providers and other related issues under Washington Apple Health, Medicare Advantage, and Cascade Select Plans and other products as offered by Community Health Plan of Washington.
• Document inquiries, complaints, and other data in computer database in an accurate, clear, and timely manner.
• Provides support to CHPW members during the Medicare Annual Election Period with includes working a variable shift and or weekend hours.
• Advises providers with the outcome of how a claim has processed and takes appropriate action on behalf of the provider and CHPW.
• Meet attendance and call quality standards.
• Perform all functions of the job with accuracy, attention to detail and within established timeframes.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion

Knowledge, Skills, and Abilities:

• Ability to gather and assess information from multiple systems, apply protocols, and determine appropriate actions.
• Ability to use MS office products such as Outlook, Word, and Excel.
• Knowledge of claims and claims processing.
• Knowledge of medical terminology and healthcare.
• Excellent verbal and written communication skills, including typing.
• The ability to summarize calls notes and create clear and concise documentation.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c