Health Services for Children with Special Needs-posted 7 days ago
Full-time • Entry Level
Hybrid • Washington, WA

As a Customer Services Associate you will work to resolve customer phone inquiries related to claims, eligibility verification, prior authorizations, pharmacy related issues and more. You will utilize strong verbal and written communication, listening and organizational skills as well as problem-solving and reasoning skills to accomplish superior customer service. Further, you will demonstrate attention to detail, ability to work in an ever-changing work flow environment, patience, professionalism, and compassion while handling difficult customers and situations. You will support enrollees and their families throughout their enrollment with HSCSN, by providing around-the-clock access to resources and assist with care coordination. A successful candidate will show flexibility and a customized approach when interacting with all types of enrollee communication styles and personalities. Finally, a strong Customer Care Services Associate will take initiative and assume responsibility where appropriate.

  • Maintain 24/7 customer service access
  • Receive calls from enrollees and/or their caregivers, assess the nature of the call, address the needs accordingly or transfer to the appropriate department
  • Answer inquiries from enrollees and/or their caregivers regarding eligibility, benefits, services, provider access and availability, and special events and programs
  • Update and maintain enrollee demographics to include; address, telephone number, email, emergency contact information
  • Process requests for PCP/PDP change and issuance of new or replacement Health Plan ID cards as necessary
  • Facilitate oral and in-person interpretation and translation services for enrollees and/or caregivers
  • Assist enrollees and or/their caregivers in scheduling appointments for doctor and hospital visits, dental appointments, transportation and coordinating with retail pharmacies on prescription needs
  • Answer inquiries from providers on various topics such as\: eligibility status of enrollees, claims filing instructions and claims status, and authorization status
  • Utilize telephonic technology tools to ensure all customer issues are tracked and resolved in a timely manner
  • Triage calls and escalations to other departments within HSCSN as appropriate
  • May perform other duties in addition to those outlined in this job description.
  • High School Diploma or GED (Required)
  • 2 years of experience in customer service, preferably in a managed care environment (Required)
  • Customer Service and Call Center experience preferred
  • Must have strong attention to detail.
  • Ability to support mission, vision and values of HSCSN and make recommendations for improvements
  • Excellent customer relation skills
  • Proficiency with computer systems and applications, especially with Microsoft Word and have good typing skills
  • Communication skills that effectively establishes and maintains professional, working relationships
  • Excellent organizational skills
  • Bilingual Language Skills
  • Fluency in English and Spanish
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