Call Center Customer Service Representative

DRISCOLL HEALTH PLAN•Corpus Christi, TX

6d•Onsite

About The Position

Driscoll Health Plan, a Medicaid Managed Care organization, is seeking a friendly, dependable, and detail-oriented Call Center Customer Service Representative to assist members and healthcare providers with questions about health insurance benefits, eligibility, claims, authorizations, crisis calls, abuse, fraud, and other healthcare-related needs. This fast-paced, phone-based role requires strong communication, patience, problem-solving abilities, and a commitment to exceptional customer service. The representative answers questions, researches and documents inquiries using multiple computer systems, and works to resolve callers’ concerns during the first call whenever possible. The role also involves helping members find healthcare providers, schedule appointments, and navigate the health plan website; collaborating with internal departments and escalating concerns when needed; and protecting confidential information in compliance with HIPAA, organizational policies, and regulatory requirements. Employees are expected to spend approximately 90% of scheduled work time handling calls, based on business needs. The position is onsite, Monday through Friday, with a schedule of either 8:00 a.m.–4:30 p.m. or 8:30 a.m.–5:00 p.m. A $3,500 sign-on bonus is offered.

Requirements

High school diploma or equivalent.
At least 6 months of experience in a call center or healthcare-related field.
Strong customer service skills, telephone etiquette, and professionalism.
Excellent verbal and written communication skills.
Ability to type at least 35 words per minute.
Strong attention to detail, organizational skills, and problem-solving abilities.
Ability to multitask and navigate multiple computer applications while assisting callers.
Comfort working in a fast-paced, high-volume call center environment.
Proficiency in Microsoft Office applications, including Outlook, Word, and Teams.

Nice To Haves

Previous experience with Medicaid, health insurance, managed care, or medical terminology.
Familiarity with call center performance metrics and goals.

Responsibilities

Meet established call center performance expectations, including spending approximately 90% of scheduled time handling phone calls, based on business needs.
Answer incoming calls from Driscoll Health Plan members and healthcare providers professionally, courteously, and promptly.
Assist callers with questions about Medicaid benefits, eligibility, claims, authorizations, pharmacy benefits, transportation, provider information, and other healthcare services.
Provide accurate information and work to resolve questions or concerns during the first call whenever possible.
Navigate multiple computer systems to research information, document interactions, and resolve customer inquiries.
Maintain accurate and detailed documentation of calls, inquiries, and resolutions.
Assist members with locating healthcare providers, scheduling appointments, and navigating the Driscoll Health Plan website.
Handle sensitive or complex situations with patience, professionalism, and empathy.
Collaborate with internal departments to resolve issues and escalate concerns when necessary.
Maintain confidentiality and comply with HIPAA regulations, organizational policies, and regulatory requirements.