ACA Exchange CSR

Amerihealth Caritas•,

3d•Hybrid

About The Position

Under the general direction of the ACA Operations Supervisor, responsible for responding in a timely, professional and courteous manner to all and member needs. This includes inbound and outbound phone calls or correspondence regarding benefit, eligibility, member premium billing, and other member issues. Provides member education and assists members with PCP selection and assignments. Assists with access to care and wellness program. Demonstrates solid knowledge of the Affordable Care Act regulations, functions and team process. Demonstrates superior skill in dealing with member issues/inquiries, team members, and co-workers. Follows internal processes and procedures to ensure all activities are performed in accordance with departmental and company policies and procedures. Demonstrate passion for providing superior customer service to our customers and continually seeks to understand the needs of those we serve. Create accurate and timely member documentation concerning all inquiries taken in accordance to established protocols to ensure resolution is provided and presented in a clear and accurate manner. Present and project a positive image of the company in and out of the office to fellow associates, members, providers and the community by being courteous, helpful, energetic, respectful and polite. Strive to resolve an inquiry on first contact while ensuring that the inquiries have been addressed to the customer’s satisfaction by using all resources in an efficient and timely manner. Provide feedback and/or solutions to supervisor to ensure continuous process improvement and provide a better customer experience. Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Maintain an awareness of all product knowledge information. Mains an awareness of Affordable Care Act regulations with regard to enrollment, billing, grace periods, special enrollment periods, and open enrollment. Understanding of the CMS Marketplace Help Desk role and directs members to CMS in accordance with that role. Able to respond to inquiries for HICS casework status Able to respond positively to support change within the department and the company. Ability to assist members with premium billing inquiries and/or issues. Forwards claims requiring external department intervention to the appropriate department or person. Monitors outstanding inquiries and works with management staff to identify and resolve areas of non-compliance. Reviews and verifies quality audit reports. Reconciles audit discrepancies, corrects in system and make appropriate changes to avoid recurrence. Responds to and resolves member and health plan claim inquiries. Actively participates in user acceptance testing functions, such as test script development, testing and documentation of test results. Willing to be flexible regarding job responsibilities and schedule, not limited to but including, overtime and holidays, as a result of contractual business requirements. Routinely meet or exceed key performance indicators. Perform other duties as assigned.

Requirements

Minimum 4 years’ experience in claims and/or call center required.
High School/GED required.
Working knowledge of PC apps in a windows based environment.
Fully available and onsite for the entire duration of training (approximately 6-7 weeks, Monday through Friday, 8:30 AM – 5:00 PM).

Nice To Haves

Associate degree preferred.
Minimum 45 wpm typing preferred.
Healthcare or Managed Care experience preferred.

Responsibilities

Respond in a timely, professional and courteous manner to all member needs via inbound and outbound phone calls or correspondence regarding benefit, eligibility, member premium billing, and other member issues.
Provide member education and assist members with PCP selection and assignments.
Assist with access to care and wellness program.
Demonstrate knowledge of the Affordable Care Act regulations, functions and team process.
Deal with member issues/inquiries, team members, and co-workers.
Follow internal processes and procedures to ensure all activities are performed in accordance with departmental and company policies and procedures.
Create accurate and timely member documentation concerning all inquiries.
Present a positive image of the company.
Resolve inquiries on first contact while ensuring customer satisfaction.
Provide feedback and/or solutions to supervisor for continuous process improvement.
Create and support an environment that fosters teamwork, cooperation, respect and diversity.
Maintain awareness of all product knowledge information.
Maintain awareness of Affordable Care Act regulations with regard to enrollment, billing, grace periods, special enrollment periods, and open enrollment.
Understand the CMS Marketplace Help Desk role and direct members to CMS.
Respond to inquiries for HICS casework status.
Respond positively to support change within the department and the company.
Assist members with premium billing inquiries and/or issues.
Forward claims requiring external department intervention to the appropriate department or person.
Monitor outstanding inquiries and work with management staff to identify and resolve areas of non-compliance.
Review and verify quality audit reports.
Reconcile audit discrepancies, correct in system and make appropriate changes to avoid recurrence.
Respond to and resolve member and health plan claim inquiries.
Actively participate in user acceptance testing functions, such as test script development, testing and documentation of test results.
Be flexible regarding job responsibilities and schedule, including overtime and holidays, as a result of contractual business requirements.
Routinely meet or exceed key performance indicators.
Perform other duties as assigned.